While jaundice can affect individuals of all ages, it most often influences newborn infants. It refers to the yellow color of the skin and the sclera, whites of the eyes, which is caused by excessive bilirubin in the body. Bilirubin is a component of the blood responsible for the breakdown of red blood cells. Jaundice is a common condition among newborn babies, however; it is a sign of many different diseases and can become a very serious problem in some infants.
The Mayo Clinic reports that bilirubin is a yellowish pigment produced in the liver and found in bile. It is a natural byproduct that results from the breakdown of red blood cells. Indirect bilirubin is the immediate product of red blood cell breakdown before reaching the liver. Once in the liver, bilirubin attaches to sugar molecules, creating direct bilirubin. Direct bilirubin is normally passed through the liver and then excreted as bile through the intestines. When bilirubin is not properly excreted, bilirubin builds up and circulates in the blood. Excessive bilirubin may indicate liver damage, disease or jaundice.
According to the University of Maryland Medical Center, jaundice occurs when bilirubin builds up faster than a newborn’s liver can break it down and eliminate it from the body. Therefore, it is marked by high levels of bilirubin in the blood. In the womb, the placenta, which nourishes the developing baby, removes bilirubin and other waste products from the infant so that it can be processed by the mother’s liver. Once the baby is born, the baby’s own liver beings to take over, but it takes time before a baby is able to remove his own waste products properly. Therefore, bilirubin levels in an infant are normally high after birth.
In “Jaundice in the Full-Term Newborn,” Shannon Cohan emphasizes that most infants are born with some degree of jaundice. Physiological jaundice typically manifests between two to three days postnatal, peaks between days two and four and clears by two weeks of age. Other than yellowing of the skin, physiologic jaundice causes no other problems. An improved understanding of jaundice has provided nurses with the ability to closely monitor this common, but potentially devastating condition, encourage breastfeeding and provide optimal care. A physical assessment of the jaundiced infant includes observing signs of sepsis, bruising, lethargy, vomiting, tenderness, excessive weight loss, dark urine and rashes.
Serum Bilirubin Levels
As discussed by Medline Plus, the majority of jaundice cases are identified on the basis of appearance of the infant’s complexion and sclera. However, differential diagnosis of the cause of jaundice is primarily derived from blood test results. Laboratory tests include total, direct and indirect bilirubin levels. When serum bilirubin is elevated, between 5 and 15 mg/dL, yellowing of the skin will occur. Higher levels, above 20 mg/dL, are indicative of a positive jaundice diagnosis and may require further testing to investigate the underlying cause. Other laboratory studies include liver enzymes, alkaline phosphatase, albumin and prothrombin. In addition, the liver and spleen are palpated to check for enlargement and to evaluate abdominal pain.
According to the University of Maryland Medical Center, treatment for newborn jaundice is not typically necessary. However, it is important to keep the baby well-hydrated with breast milk or formula and to feed frequently, which encourages bowel movements to assist in bilirubin elimination. If bilirubin levels are excessive, the baby may be placed under special lights, known as phototherapy. The lights work by helping to break down bilirubin in the skin.
Underlying Causes and Long-Term Effects
Meredith Porter and Beth Dennis in “Hyperbilirubinemia in the Term Newborn” describe that risk factors for newborn jaundice consist of both infant and neonatal factors. Among others, these include maternal blood type, ethnicity, illness, pharmaceutical use and breastfeeding. Neonatal factors include trauma at birth, need for pharmaceuticals, excessive weight loss, infection, infrequent feedings, male gender and prematurity. If jaundice goes undiagnosed or is unable to be treated, long-term consequences may occur. Irritability, seizure, chronic fever, cerebral palsy, hearing loss, dysphagia, mental retardation and brain damage may develop.
- MayoClinic.com: Bilirubin test
- University of Maryland Medical Center: Newborn jaundice
- "Pediatric Nursing”; Jaundice in the Full-Term Newborn; Shannon Cohan; May/June 2006
- MedlinePlus: Bilirubin – blood
- "Hyperbilirubinemia in the Term Newborn; American Family Physician; Meredith Porter and Beth Dennis; February 2002