Why Is Jaundice in Children Becoming More Prevalent These Days?

Newborns often suffer from jaundice, which is the yellowing of the skin and eyes in children. Within two to three days of delivery, over 60% of newborns show jaundice symptoms. Bilirubin, a yellow substance produced when red blood cells breakdown, builds up and causes jaundice in children. Normally, the liver breaks down and excretes bilirubin. However, because infants’ livers are still developing, they are unable to do this as effectively as the mother’s liver did before delivery.

The yellow colour in neonates is caused by excess bilirubin that should be eliminated by faces but is instead reabsorbed into the blood stream. Increased levels of bilirubin in the blood is called hyperbilirubinemia which can be either direct or indirect hyperbilirubinemia.A prototype example of indirect hyperbilirubinemia is physiologic jaundice. Phototherapy is useful if levels are above the normogram cut-offs. Direct hyperbilirubinemia on the other hand is associated with dark or high coloured urine and diaper staining. Here phototherapy is not useful and treatment depends on the underlying cause.

There are two main types of jaundice in children:

Physiologic jaundice: 60% of babies suffer from physiological jaundice, which is a rather common condition. It happens when the body does not eliminate enough bilirubin quickly. Usually, by the time the infant is around two weeks old, the indirect hyperbilirubinemia goes away on its own. Treatment can be necessary if it lasts longer.

Pathologic jaundice: Many conditions, including infections, hormone imbalances, and genetic disorders, affect the ability of the liver to properly process bilirubin, which can lead to this kind of jaundice. It is necessary to determine and address the underlying issue in these circumstances.

What Causes Jaundice in Children?

Jaundice Disease in Children Symptoms & Treatment in India, Hyderabad

The baby’s bilirubin is broken down by the mother’s liver throughout pregnancy. This function is taken over by the baby’s liver after delivery. Jaundice develops when the baby’s liver cannot process the excess bilirubin on its own. Since a newborn’s liver is still developing, jaundice is fairly common. This condition typically resolves for most babies within a few days or weeks as their liver matures and effectively processes bilirubin, preventing it from building up. The physiological immaturity of the liver results in physiological jaundice which is indirect hyperbilirubinemia, usually self-resolving.

In rare cases, jaundice in children might indicate a more serious health issue. If jaundice persists, additional testing may be required to determine the underlying cause and appropriate treatment. Some conditions that can lead to ongoing jaundice include:

Causes of Jaundice in Children

• Blood type mismatch: If the mother’s and the baby’s blood types differ, the baby’s red blood cells can breakdown more quickly than usual, which raises the level of bilirubin.
• Blood cell disorders: Jaundice can be brought on by illnesses such as sickle cell anaemia or a deficiency in glucose-6-phosphate dehydrogenase (G6PD), which can affect how well red blood cells function.
• Infections: Viral infections (like CMV) or bacterial infections (such as urinary tract infections) can cause jaundice. More serious infections, like herpes simplex or sepsis, may also be indicated by jaundice.
• Endocrine disorders: Hormonal conditions such as hypothyroidism (underactive thyroid) or hypopituitarism can lead to jaundice.
• Bile flow blockages: Conditions that obstruct bile flow from the liver, such as biliary atresia or choledochal cysts, can cause jaundice. Some of these conditions, like cystic fibrosis or Alagille syndrome, are genetic. Here hyperbilirubinemia is a direct hyperbilirubinemia associated with yellowish/dark urine. This type of jaundice (direct hyperbilirubinemia) is different and is known as neonatal cholestasis which requires time-bound management. Here Phototherapy is ineffective and the cause of direct hyperbilirubinemiais usually intrinsic liver disease or biliary flow obstruction.
• Genetic disorders: Jaundice can also result from genetic diseases like Gilbert syndrome (usually harmless) or galactosemia (which requires a special diet). While many genetic disorders can cause jaundice, most are extremely rare.

Symptoms of Jaundice in Children

The symptoms of jaundice in babies vary depending on the cause and severity, but may include:

• A yellowish color to the skin, often starting on the face and scalp
• A yellowish tint to the white parts of the eyes (sclera)
• Yellowing that extends to the rest of the body (in moderate jaundice)
• Yellowing of the palms and soles (in severe jaundice)
• Unusual drowsiness
• Feeding difficulties
• Occasionally, light-colored stools and dark urine. Persistently pale (white /clay) colored stools lasting beyond two weeks of age, should prompt an early visit to the neonatologist/pediatric gastroenterologist.

What Children Are at Risk for Jaundice?

Some babies are more likely than others to develop jaundice. Among them are:

• Premature babies: Babies born before 37 weeks may have livers that are not fully developed, which makes it more difficult for them to properly handle bilirubin.
• Breastfed babies: Jaundice is more common in babies who have trouble breastfeeding, whether due to poor feeding or insufficient milk production by the mother. If a baby doesn’t get enough breast milk in the first days or weeks, they may not have enough bowel movements to eliminate bilirubin. This is known as breastfeeding jaundice.

Furthermore, breast milk itself may occasionally be a factor in jaundice. Some of the ingredients in breast milk are thought to slow down bilirubin’s processing. We call this jaundice from breast milk. While jaundice of this sort normally goes away on its own in a few weeks or months, formula feeding may be required if bilirubin levels get too high until the jaundice goes away.

Diagnosis of jaundice in children

Newborns should be tested for jaundice before leaving the hospital or birthing center. Babies at higher risk for jaundice, or those showing prolonged symptoms, might need to be rechecked after a few days. Your child’s healthcare provider can advise if additional testing is necessary. The doctor will probably prescribe a blood test for “total and direct bilirubin” if the infant is still jaundiced after two weeks of age (or up to three weeks for breastfeeding newborns). This can help identify the kind of jaundice and determine whether any other tests are needed.

The physician will first inspect the baby to rule out jaundice. Additional tests can include:

• Skin test: Uses a special light to assess bilirubin in the skin.
• Blood test: Determines the level of bilirubin in the blood.

How Is a Child’s Jaundice Treated?

When it comes to jaundice that is not caused by illness, it usually goes away on its own in two weeks. It could be necessary to test the baby’s blood during this period to make sure the bilirubin levels are rising.

Certain infants need phototherapy, which involves exposing the infant’s skin to a particular kind of intense blue light. Most newborns can safely be exposed to these “bili lights,” which produce a chemical reaction in the skin that facilitates the body’s easier removal of bilirubin through the urine and stools. A few hours to several days may pass during phototherapy, depending on the patient’s bilirubin levels.

There are two types of phototherapy:

• Conventional phototherapy: The baby is placed on a bed under bili lights, which are lamps that emit a special blue light. Soft eye patches protect the baby’s eyes during treatment.
• Fiberoptic phototherapy: This is a bili blanket, which is a soft pad that has blue phototherapy LEDs inside of it. During therapy, the infant is put on or covered with the bili blanket.

If phototherapy does not sufficiently lower bilirubin levels, a baby with severe jaundice may require a blood exchange transfusion, where some of the baby’s blood is replaced with donor blood. However, this is rarely needed.

For children with pathologic jaundice, which is caused by a disease, the treatment depends on the underlying cause. Various tests may be needed to determine the problem and appropriate treatment.

For those newborn jaundice conditions which are a result of direct hyperbilirubinemia, the treatment depends on the underlying cause. Here usual causes include biliary atresia, infection, genetic etiologies like Alagille syndrome, etc. For this set of cholestatic (direct) jaundice conditions, phototherapy is not useful. They require timely evaluation and management.

Complications of Jaundice in children

A baby’s brain may be damaged by bilirubin if their blood bilirubin levels get dangerously high. This damage might be either permanent (chronic bilirubin encephalopathy) or reversible (acute bilirubin encephalopathy). Severe hyperbilirubinemia must be avoided in infants at high risk of jaundice by fast, early treatment and routine monitoring.

Prevention of Severe Hyperbilirubinemia

Preventing severe hyperbilirubinemia is crucial to avoid serious complications. Babies at risk should have regular follow-up visits with their doctor, scheduled at hospital discharge. The following applies to healthy, full-term, or late preterm infants (born within a month of their due date).

• Screening: Experts recommend testing all newborns for bilirubin levels before leaving the hospital, regardless of age. This is especially important for babies showing jaundice within the first day of life, requiring repeated tests.
• Monitoring: Parents, caregivers, and healthcare providers should closely monitor babies who develop jaundice. Hyperbilirubinemia is usually easy to prevent and treat early on, but delayed treatment can lead to serious, irreversible complications. Contact your baby’s healthcare provider immediately if you notice worsening jaundice.
• Prompt treatment: Babies with high bilirubin levels should receive immediate treatment from a qualified healthcare provider to safely lower bilirubin levels and prevent brain damage. Delaying treatment should be avoided.

If Your Child Is Jaundiced

Stay calm. The great majority of episodes of jaundice are mild and manageable. Jaundice is typically extremely curable for babies, even if they need to be hospitalized or given special care. Its detrimental effects are typically avoidable if detected early, and medical professionals will make every effort to help in your baby’s recovery. As you wait, be sure to feed your child frequently, monitor any changes in symptoms, and contact your pediatrician if you have any worries

Conclusion

Jaundice is common in newborns and typically resolves on its own within one to two weeks. However, it’s important to check your baby’s bilirubin levels. If jaundice in children is left untreated, high bilirubin levels can lead to serious health issues, including cerebral palsy, deafness, and kernicterus, a type of brain damage.Direct hyperbilirubinemia is charecterised by jaundice associated with dark/yellow urine, which requires timely evaluation and management. If you have any questions or concerns about your baby’s medical condition, the best person to ask is their healthcare professional.