Safe and Effective Treatments for Jaundice in Newborns
Jaundice in newborn babies is very common and it affects 60% of babies. When the…
Jaundice in newborn babies is very common and it affects 60% of babies. When the baby’s skin and eyes start appearing yellow then it is the case of jaundice. Most babies recover from jaundice within a couple of days. However, some babies require intensive treatment to heal.
Physiological jaundice happens due to the common newborn condition. A substance called bilirubin starts forming in the blood. A newborn baby’s liver is still developing and it is unable to clear out the bilirubin leading to its excess collection in the bloodstream. 75% of the jaundice cases account for physiological jaundice.
Several factors contribute to increased bilirubin levels in physiological jaundice.
- A higher number of red blood cells in newborns,
- shorter red blood cell lifespan
- an immature liver system
Pathological jaundice in newborns occurs due to some underlying conditions that affect the normal breakdown and elimination of bilirubin. These conditions may include blood group incompatibilities between the mother and the baby, diabetes in the mother, hypothyroidism, rhesus diseases, and Urinary tract infection.
Certain risk factors increase the likelihood of newborns developing pathological jaundice. Premature infants have a higher risk due to their underdeveloped liver function. Babies born to mothers with diabetes or those who had previous infants with jaundice are also at an increased risk. In some cases, a family history of genetic disorders may also cause pathological jaundice.
Diagnostic Procedures for Jaundice in Newborns
Visual assessment is the initial step in diagnosing jaundice in newborns. Firstly, healthcare professionals examine the skin and whites of the eyes to detect any yellow discoloration. Additionally, jaundice typically starts at the head and progresses downwards, which facilitates observation in the face, eyes, and chest. Moreover, the assessment will be conducted in good and natural light..
To determine the severity of jaundice, a grading system called the Kramer’s Scale is often employed. Additionally, it serves as a non-surgical method for assessing the degree of jaundice. The body is divided into 5 zones, and a score is assigned based on the level of yellow discoloration observed in each zone. Consequently, this severity grading system assists healthcare professionals in tracking the advancement of jaundice and facilitating informed treatment decisions.
Measuring bilirubin is very important for newborns. The bilirubin levels in the blood let the doctors know whether the baby is recovering from jaundice or if any other intensive treatment is required. .
a) Total Serum Bilirubin (TSB) Test: As the name suggests TSB measures the total number of bilirubin in the blood. A blood sample is taken from the baby’s heels and then sent for diagnosis.
b) Direct or Conjugated Bilirubin Test: This test measures the bilirubin levels that the liver has processed and is ready to eliminate from the body. If the bilirubin levels do not eliminate and it increases in the bloodstream then it suggests some underlying health conditions in the liver such as hepatitis, gallstones and blockages.
A few more blood tests are conducted if the baby’s jaundice lasts longer than 2 weeks.
Safe Treatment Options for Jaundice in Newborns
The bilirubin in the baby’s body is broken down by phototherapy using a specific type of light. Transitioning to the next step, the baby is placed without clothes in an incubator or cot with lights covering it. Additionally, to ensure the baby’s safety, their eyes are covered with protective goggles.
3 types of photographs are mostly used to treat newborn jaundice.
- Most newborns with jaundice are treated with conventional phototherapy, which uses fluorescent lights, specifically blue-green ones. This particular wavelength of light is considered the most effective for breaking down the baby’s bilirubin levels.
- Fibre optic phototherapy uses a fibre optic blanket or pad that emits light directly onto the baby’s skin. Absorption of this light breaks down the bilirubin. The baby’s skin might be a little normal red.
- LED (light-emitting diode) phototherapy: As the name suggested it involves the use of LED lights instead of fluorescent lights. LED lights have a higher dose of light and are more efficient in eliminating bilirubin.
Phototherapy is generally safe for newborns and most babies’ response to the treatment is also good. But there are certain precautions that the healthcare providers take to ensure the safety of the baby. The baby’s eyes have to be covered with goggles or eye patches in order to ensure that the baby’s eyes are shielded from the bright light. Additionally, for safety purposes, it is important to monitor the baby’s temperature to eliminate the possibility of burns. The doctor will stop the therapy occasionally so that the baby can be fed and is not dehydrated.
Exchange transfusion is a life-saving procedure. When phototherapy fails to reduce bilirubin levels, an exchange transfusion is administered. Indications for exchange transfusion include high bilirubin levels, signs of severe jaundice-related complications, or specific risk factors identified through a medical evaluation.
An exchange transfusion is done by revving a small amount of the baby’s blood and replacing it with donor blood. This process continues till the bilirubin levels drop. exchange transfusions are associated with some risks such as the baby may show some allergic reactions to the donor blood, infections in the baby, blood clotting issues, and complications related to the blood vessels
Exchange transfusion achieves high effectiveness by replacing the blood of the baby with blood that contains low bilirubin levels.
Effective Non-Pharmacological Interventions
Feeding your little one with either breast milk or formula plays a significant role in ensuring their digestive system functions smoothly and effectively eliminates bilirubin from their body. When babies are fed at frequent intervals, more bilirubin is eliminated from their bodies.
Colostrum is the initial milk produced by the mother’s breasts. It is thick and yellow. Colostrum is rich in nutrients and antibodies. If you feed the baby colostrum, the chances of the baby getting jaundice are significantly reduced. Doctors also recommend frequent breastfeeding for the baby. More breastfeeding will ensure that the baby passes frequent stools and bilirubin also clears out with it.
The act of skin-to-skin contact is also known as kangaroo care. It involves placing the baby on the bare chest of either mother or father. Being close to the body will keep the baby warm and stabilise body temperature. The baby can listen to the heartbeat just like it used to do in the womb, which would reduce stress and eliminate bilirubin
The skin-to-skin practice will also increase the bonding between the parent and the baby. Being close to the bare skin the baby will receive warmth and the chances of temperature fluctuation, which causes jaundice, reduces greatly.
Pharmacological Treatments for Jaundice in Newborns
Ursodeoxycholic acid (UDCA) is a naturally occurring bile acid that helps in reducing the level of bilirubin in the blood. UDCA increases the bile production which eliminates bilirubin from the digestive system. Countless clinical trials have also shown that UDCA could reduce the hospitalization period.
Efficacy and safety profile
UDCA has shown amazing results in the treatment of newborn jaundice. Adding UDCA while treating jaundice reduces the time of phototherapy and eliminates bilirubin faster.
Like any other medicine, UDCA also has some side effects and doctors have to monitor the baby closely.
Phenobarbital is used as a treatment option when phototherapy fails at bringing the bilirubin levels down in the baby. It is a drug which requires a doctor’s strict supervision. Other than newborn jaundice, phenobarbital is also used to treat other severe conditions like epilepsy and hypnotics.
Phenobarbital is a medication that requires careful monitoring. Additionally, the medication causes drowsiness, and as a result, the doctor adjusts the dosage according to the baby’s age and weight. The baby might get irritated, and you may encounter some difficulties while feeding. Only in rare cases, it causes respiratory failure. Due to the nature of the drug, it becomes important for healthcare professionals to monitor closely the baby’s response to phenobarbital therapy.
Monitoring and Follow-Up Care
Importance of monitoring bilirubin levels
Monitoring the bilirubin levels is important to know whether the baby is recovering from jaundice or is it getting severe. Early detection of bilirubin levels lets healthcare professionals make an informed decision and save the baby from complications.
Frequency and duration of follow-up visits
The baby’s age, bilirubin levels, and the severity of the jaundice are among the major factors that determine the frequency and duration of follow-up visits. In the first few days, the doctors closely monitor the newborn baby with jaundice. For mild jaundice that resolves in a day or two, only one follow-up visit of short duration is necessary. If the baby has recovered from a severe case of jaundice then the doctor might want to run some tests. The duration of visits in these cases is more.
Complications and long-term effects of jaundice
Most babies recover from jaundice without any complications. But babies who have recovered from severe jaundice, or babies whose jaundice was not detected for a long duration may suffer from a condition called kernicterus. Furthermore, Kernicterus can lead to long-term neurological impairments, including hearing loss, intellectual disabilities, movement disorders, and brain damage.
If your baby is being diagnosed with jaundice, don’t worry. It is widespread and most babies recover from jaundice easily. For the recovery, mostly babies recover from non-surgical methods like phototherapy. When the bilirubin levels are extremely high and pose a threat to the baby’s life then other interventions like exchange transfusion, and pharmacological treatments are administered. Parents and healthcare professionals need to keep an eye on the baby after it’s born. Additionally, they should check for signs of the eyes and skin being yellow. Early detection of jaundice, in turn, will result in speedy recovery without any complications.