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Neonatal jaundice; Bilirubin; Physiological jaundice; Pathological jaundice; Breastfeeding jaundice; Diagnosis

Introduction

Neonatal jaundice is a common condition observed in newborns, characterized by the yellowing of the skin and sclera (the white part of the eyes) due to elevated levels of bilirubin in the blood. Bilirubin is a yellow compound formed during the breakdown of hemoglobin in red blood cells. While neonatal jaundice is usually benign and resolves without intervention [1,2], it can lead to serious complications if left untreated. This article discusses the types, causes, risk factors, diagnosis, treatment, and prevention of neonatal jaundice.

Types of neonatal jaundice

Neonatal jaundice can be classified into two main types:

Physiological jaundice:

This is the most common type and occurs in nearly 60% of newborns. It typically appears after 24 hours of birth and usually resolves within two weeks. Physiological jaundice is a result of the immature liver's inability to efficiently process bilirubin during the first few days of life [3]. The liver matures over time, allowing for better bilirubin clearance.

Pathological jaundice:

Pathological jaundice is less common but requires immediate medical attention. It can manifest within the first 24 hours of life or persist beyond two weeks. This type can result from various underlying conditions, including hemolytic diseases, infections [4], metabolic disorders, or liver dysfunction. It is crucial to identify and treat the underlying cause to prevent complications.

Causes of neonatal jaundice

The causes of neonatal jaundice can be broadly categorized into three groups:

Increased bilirubin production:

Conditions leading to excessive breakdown of red blood cells (hemolysis) can increase bilirubin production. Common causes include:

Hemolytic disease of the newborn (HDN): Often caused by Rh or ABO incompatibility, where the mother’s immune system attacks the baby's red blood cells [5].

Bruising: Birth trauma can lead to increased red blood cell breakdown.

Decreased bilirubin conjugation:

Conditions that impair the liver's ability to process and conjugate bilirubin can lead to elevated levels. Common causes include:

Physiological jaundice: As previously mentioned, due to the immaturity of the liver.

Breastfeeding jaundice: Occurs in breastfed infants due to inadequate intake of breast milk, leading to dehydration and reduced bilirubin clearance [6].

Impaired bilirubin excretion:

If the liver is unable to excrete bilirubin into the bile due to obstruction or liver disease, jaundice can occur. Common causes include:

Biliary atresia: A congenital condition where bile ducts are absent or damaged.

Infections: Certain infections can affect liver function [7].

Risk factors

Several factors may increase the risk of developing neonatal jaundice, including:

Prematurity: Infants born before 37 weeks of gestation have an immature liver, increasing the likelihood of jaundice.

Blood type incompatibility: Mothers with blood types that are incompatible with their babies (e.g., Rh or ABO incompatibility) are at higher risk.

Family history: A family history of jaundice or hemolytic disease increases the risk for newborns.

Maternal conditions: Conditions such as diabetes or infections during pregnancy can contribute to increased jaundice risk in the infant.

Diagnosis

Diagnosing neonatal jaundice involves a thorough clinical assessment and laboratory tests. The following steps are typically taken:

Clinical examination: Healthcare providers assess the newborn's skin color and sclera for jaundice. The timing of onset, the duration of jaundice, and the presence of risk factors are noted.

Total bilirubin measurement: Blood tests measure total bilirubin levels, which are categorized into direct (conjugated) and indirect (unconjugated) bilirubin. Elevated indirect bilirubin levels are common in physiological jaundice, while high direct bilirubin levels may indicate pathological causes.

Coombs test: If hemolytic disease is suspected, a Coombs test may be conducted to check for the presence of antibodies against red blood cells.

Additional Tests: Depending on the clinical scenario, further tests such as blood type and cross-match, liver function tests, or imaging studies may be ordered to identify underlying causes.

Treatment

The management of neonatal jaundice depends on its severity, underlying cause, and the infant's age. Treatment options include:

Phototherapy:

The most common treatment for jaundice involves [8] exposing the infant to specific wavelengths of light. Phototherapy helps convert bilirubin into water-soluble forms that can be easily excreted by the liver and kidneys.

Exchange transfusion:

In severe cases, where bilirubin levels are dangerously high and phototherapy is ineffective, an exchange transfusion may be performed. This procedure replaces the infant's blood with donor blood to quickly reduce bilirubin levels.

IV immunoglobulin (IVIG):

In cases of hemolytic disease due to blood type incompatibility, administering IVIG can help reduce hemolysis and bilirubin levels.

Supportive care:

Ensuring adequate hydration and nutrition is vital. In breastfeeding jaundice [9], improved feeding practices may alleviate the condition.

Prevention

Preventive measures can help minimize the risk of developing neonatal jaundice:

Early identification: Routine screening for jaundice within the first 24 hours of life can help identify and manage jaundice promptly.

Education: Educating parents about the signs of jaundice and the importance of seeking medical advice can facilitate early intervention [10].

Optimizing feeding practices: Ensuring that infants are feeding adequately, whether through breastfeeding or formula, can reduce the risk of jaundice.

Managing maternal conditions: Proper management of maternal health conditions during pregnancy, including diabetes and blood type incompatibilities, can help prevent neonatal jaundice.

Conclusion

Neonatal jaundice is a common yet significant condition that requires careful monitoring and management. While most cases are physiological and resolve without intervention, it is essential to identify and treat pathological jaundice to prevent complications. Early detection, effective treatment strategies, and parental education are crucial in ensuring the health and well-being of newborns affected by this condition. As research continues to evolve, improving clinical practices will help minimize the incidence and impact of neonatal jaundice on infants and families.

1. Johnson CD, Haldeman S (2018) Eur Spine J 27: 925-945.

, ,

2. Dent M, Pahor M (2015) J. Health Organ Manag 29: 546-555.

, ,

3. Braithwaite J, Vincent C (2020) BMC Med 18: 340.

, ,

4. Bombard Y, Baker GR, Orlando E (2018) Implement Sci 13: 98.

, ,

5. Ferrante S (2016) Appl Clin Inform 7: 191-210.

, ,

6. Bisognano M, Schummers D (2014) BMJ 349: 5852.

, ,

7. Viitanen J, Valkonen P (2022) Yearb Med Inform 31: 136-145.

, ,

8. Dullabh P, Sandberg SF (2022) J Am Med Inform Assoc 29: 1233-1243.

, ,

9. Conrad DA, Dowling WL (1990) Health Care Manage Rev 15: 9-22.

, ,

10. Gröne O, Garcia-Barbero M (2023) J Adv Nurs 79: 83-100.

, ,