Jaundice in Newborns (Hyperbilirubinemia)

DEFINITION

Hyperbilirubinemia is a condition in which high levels of bilirubin in the blood. Yellow in infants is generally caused by the accumulated chemical called bilirubin in the baby's blood and tissue (physiological jaundice). Normally, bilirubin is processed in the liver, but the liver newborns will require up to several days after birth to be ready to process bilirubin. 

CAUSE

Red blood cells are old, broken and removed from the abnormal blood circulation, mainly in the spleen. During the disposal process, hemoglobin (the protein that carries oxygen in red blood cells) is broken down into a yellow pigment called bilirubin. Bilirubin is then carried to the liver, where the bilirubin is chemically altered and then released into the gut as part of bile.

On most newborns, levels of bilirubin in the blood is normally increased while, namely in the first few days after birth. Increased levels of bilirubin cause the baby's skin is yellow (jaundice).

In adults, the bacteria normally found in the intestines will break bilirubin. But in newborns, these bacteria are very few so much bilirubin is excreted through feces that causes bright yellow stool. Newborns also have an enzyme in the intestines that may change some of bilirubin and absorb it back into the blood, causing jaundice (yellow). Due to increased blood levels of bilirubin, the jaundice becomes increasingly clear. At first the baby's face looked yellow, then the chest, legs and feet are also yellow. Hyperbilirubinemia and jaundice usually disappear after the first week.

Another cause yellow in infants

Yellow baby can also be caused by disease or other conditions, such as:

-Jaundice breastfeeding (breast milk jaundice)

Very high levels of bilirubin can be caused by excessive formation of bilirubin disposal or disorder. Sometimes the babies are old enough to get the milk, bilirubin levels increase progressively during the first week, a condition called jaundice breastfeeding (breast milk jaundice).

-ASI less

breast only slightly producing colostrum in the first few days after birth. Lack of breast milk received by the infant can affect heart function.

-Neonatal hepatitis

some types of viral hepatitis can lead to the baby, such as cytomegalovirus, rubella, and hepatitis A, B and C. Infants with neonatal hepatitis may be exposed to a viral infection in the womb or in the first month of life.

-Rh (Rhesus) and ABO blood group incompatibilities (blood group incompatibility)

mother produces antibodies that attack the red blood cells of the baby during the final semester of pregnancy. This means that the level of red blood cells damaged to be eliminated by a higher body, which in turn will trigger a rise in bilirubin level, so that the baby can be born with anemia and suffered heavy yellow within a few hours after birth.

-Hemolytic anemia

This could be an inherited autoimmune disorder, in which the baby's immune system destroys red blood cells. Also can be a complication of other disorders, such as sepsis (serious infection).

-Galactosemia

galactose is milk sugar. Infants with galactosemia lack the enzyme necessary to break down galactose. High levels of galactose can cause liver cirrhosis and eventually yellow.

-Biliary Atresia

channel flow of bile from the liver to the small intestine is damaged, the reason is unknown. Without the bile duct, bile accumulates in the liver and cause symptoms of yellow.

SYMPTOMS

Hyperbilirubinemia make babies become yellow (jaundice), which can be seen on the skin and eyes of a baby.

Yellow symptoms in infants depends on the cause and severity, but generally:

·         Yellowing of the skin, usually appears first on the face and scalp

·         Yellow in the white part of the eye (sclera)

·         Yellow spread on the skin (yellow medium)

·         Palms and soles yellow (yellow weight)

·         Unusual drowsiness

·         Difficulty eating

·         In some cases, light-colored feces or feces and dark urine.

Most cases of hyperbilirubinemia harmless, but sometimes very high levels of bilirubin can cause brain damage (kernicterus).

Kernicterus usually occurs in extremely premature infants or infants with severe pain. Kernicterus Symptoms may include:

- sleepy

- Not strong suck

- gag

- High-pitched cries

- Fontanel prominent

- Opisthotonos (arched body position, closer to the back of the neck)

- Seizures

- May be followed by death

Long-term effects of kernicterus is mental retardation, cerebral palsy (abnormal muscle control, cerebral palsy), deafness and eye can not be moved up.

DIAGNOSIS

Diagnosis is based on symptoms that exist, physical examination and blood test results showed elevated levels of bilirubin.

TREATMENT

Yellow baby treatment depends on the cause. Among the yellow treatment in infants, are:

·         Yellow light - If the baby is healthy and looks no problem, usually no treatment is necessary. Baby's liver takes only a few days to process the bilirubin properly prepared.

·         Medium yellow - Phototherapy is the treatment most often applied (see photo below). Phototherapy will change bilirubin in the baby's skin becomes less hazardous chemicals, so that bilirubin can be excreted through the urine or faeces, without having first converted by the liver. The baby will be placed in a warm incubator under a blue light. To maximize exposure to light, baby clothes will be uninstalled and use protective / blindfold. Phototherapy is usually done for one or two days. To prevent dehydration and increase the excretion of bilirubin, babies need to eat regularly every three to four hours.

·         Heavy yellow - phototherapy remains the primary treatment, but in cases of severe yellow, blood transfusions may be required. But this is very rare.

·         Rh (Rhesus) and ABO blood group incompatibilities (blood group incompatibility) – cause differences in blood types between mother and baby. This situation caused the baby to get the antibodies from the mother that made the breakup of red blood cells in infants. Immunoglobulin can be given intravenously to reduce the levels of maternal antibodies to the fetus, thus reducing jaundice in infants.

·         Jaundice breastfeeding (breast milk jaundice) - in the breast milk jaundice, sometimes breast-feeding should be discontinued for 1-2 days. Soon after bilirubin levels begin to decline, the milk should be given back.

·         Yellow for lack of breastfeeding - continue breastfeeding and phototherapy is still being done, Feeding the baby more often will speed up the disposal of the contents of the intestine, thereby reducing the reabsorption of bilirubin from the gut and reduce levels of bilirubin in the blood.

·         Neonatal hepatitis - there is no specific medical treatment. Usually given vitamin and mineral supplements, or drugs to increase the flow of bile.

·         Hemolytic anemia - treatment depends on the cause. For example, hemolytic anemia caused by malaria parasite infection treated with anti-malarial drugs.

·         Galactosemia - The main treatment is to ensure baby's diet does not contain galactose or lactose. Typically, performed by stopping breastfeeding and using a special formula.

·         Biliary atresia - usually surgery to attach or connect a small duct from the liver to the small intestine so that bile flow properly.

REFERENCE

D, Steven. Jaundice in Healthy newborns. Kids Health. 2011.

G, Eric. N, Ursula. Jaundice in newborns. Merck Manual Home Health Handbook. 2009.

L, Kimberly G. Kernicterus. Medline Plus. 2011.

Mayo Clinic. Infant Jaundice. 2011.

Web MD. Jaundice in newborns (hyperbilirubinemia). 2010.