Yellow coloration of skin due to bilirubinBilirubin A yellow substance produced when red blood cells break down. High bilirubin levels in newborns with HDFN can cause jaundice or, in severe cases, brain damage. accumulation, commonly known as jaundiceJaundice A common symptom of HDFN, jaundice is caused by excess bilirubin and is characterized by a yellow tint to the skin or eyes., is a common condition in newborns. There are many possible causes, ranging from hemolytic disease of the fetus and newborn (HDFN) to thyroid abnormalities, and the importance of an accurate diagnosis was illustrated in a recently published case report in The Journal of Nurse Practitioners.
Jaundice is caused by the accumulation of a molecule called bilirubin in the blood. This molecule is a byproduct of the breakdown of hemoglobin, the protein responsible for holding the oxygen transported in red blood cells. Bilirubin is normally transported to the liver, where it undergoes a transformation called conjugation. Conjugated bilirubin is then excreted from the body through the intestines.
Any process that increases red blood cell destruction or prevents its metabolism in the liver will lead to bilirubin accumulation, known as hyperbilirubinemiaHyperbilirubinemia A common cause of jaundice, this refers to higher than normal bilirubin levels in the blood.. Jaundice is the most characteristic symptom of hyperbilirubinemia. In the newborn, excess bilirubin can enter the brain and cause kernicterusKernicterus A rare but serious brain condition caused by very high bilirubin levels., a condition linked to permanent brain damage.
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“Therefore, it is crucial for clinicians to appropriately test bilirubin levels and for families to be aware of their baby’s risk factors and recommended follow-up,’” the authors wrote.
The case study involved a four-year-old boy discharged from the hospital two days after birth with low weight. When he was born, the infant had no significant risk factors for jaundice such as HDFN, premature delivery or infection. However, two days after discharge, the parents noticed a yellowish coloration of the skin and brought him to the hospital.
Other than marked jaundice, the doctors observed no other significant abnormalities with a physical exam. Bilirubin levels were lower than those in a healthy baby, which could cause neurological complications if left untreated.
Currently, physicians are capable of assessing the risk of a newborn with jaundice developing severe disease. To do this, they often use calculators such as the Bilitool to assess factors such as the gestational age at birth, bilirubin levels and the presence of risk factors such as a history of HDFN.
Because the patient had no significant risk factors, he was monitored as an outpatient with a strict follow-up plan and began showing improvement in weight and bilirubin levels in the following weeks.
