Jaundice happens when a chemical called bilirubin (yellow pigment of red blood cells) builds up in the baby’s blood. During pregnancy, the mother’s liver removes bilirubin for the baby, but after birth the baby’s liver must remove the bilirubin, and in some babies the liver might not be developed enough to get rid of bilirubin. When too much bilirubin builds up in a new baby’s body, the skin and whites of the eyes might look yellow. This yellow coloring is called jaundice.
Most infants develop visible jaundice due to elevation of unconjugated bilirubin concentration, or “hyperbilirubinemia’ during their first week. This is called physiological jaundice and is the most common type as it can happen with no additional or underlying health conditions.
- Term infants – jaundice lasts for about 10 days with a rapid rise of serum bilirubin up to 204 μmol/l (12 mg/dL).
- Preterm infants – jaundice lasts for about two weeks, with a rapid rise of serum bilirubin up to 255 μmol/l (15 mg/dL).
Severe newborn jaundice (defined as total serum bilirubin (TSB) ≥ 20 mg/dl), if untreated, can result in long-term brain damage and cognitive difficulties, including kernicterus. Jaundice related morbidity and mortality is disproportionately high in low-income and middle-income countries compared to more developed countries. (2) Tools that enable early detection and management of jaundice are important to prevent the devastating consequences of untreated severe jaundice. Such tools include simple ways to measure bilirubin, tools to enhance visual assessment of jaundice, and effective phototherapy units
Related Buyers Guides
Diagnosing Newborn Jaundice (Bilirubin Analyzers, Jaundice Meters, Visual tools)
Diagnosis is typically by measuring the serum bilirubin in the blood. In neonates, the gold standard to measure hyperbilirubinemia total serum bilirubin (TSB) which requires a heel-prick blood sample from the patient and may not be feasible or practical as it is invasive and requires laboratory capabilities which are not always available. Visual inspection of the skin or eyes (sclera) is an instant and cost-free way of estimating the serum bilirubin, but it has limitations in accuracy particularly for screening non-white newborns. Transcutaenous bilirubinometers offer an alternative way of estimating serum bilirubin and can be non-invasive, fast, and relatively inexpensive. (6) Read more in our Buyers Guide for Bilirubinometers
Treating Newborn Jaundice with Phototherapy
Depending on the age and health status of a newborn, most babies with high levels of total serum bilirubin levels should receive phototherapy, which is a specific type of colored light (specific frequency of blue light) which may be provided either with lamps, special beds, or blankets. Read more about Phototherapy in our Buyers Guide for Phototherapy.
In more severe cases, a baby may require an exchange transfusion, or a small amount of blood from a donor or a blood bank replaces the baby’s damaged blood with healthy red blood cells.
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References and Acknowledgments
(1) Olusanya, BO; Teeple, S; Kassebaum, NJ (February 2018). “The Contribution of Neonatal Jaundice to Global Child Mortality: Findings From the GBD 2016 Study”. Pediatrics. 141 (2): e20171471. doi:10.1542/peds.2017-1471. PMID 29305393.
(2) Olusanya BO, Ogunlesi TA, Slusher TM: Why is kernicterus still a major cause of death and disability in low-income and middle-income countries? Arch Dis Child 2014;99:1117-1121
(3) National Institutes for Health and Clinical Excellence. Neonatal jaundice. (clinical guidelines 98), 2010.
(4) Bhutani VK, Zipursky A, Blencowe H, et al. . Neonatal hyperbilirubinemia and rhesus disease of the newborn: incidence and impairment estimates for 2010 at regional and global levels. Pediatr Res 2013;74 86–100.
(5) Slusher, Tina M et al. “Burden of severe neonatal jaundice: a systematic review and meta-analysis.” BMJ paediatrics open vol. 1,1 e000105. 25 Nov. 2017, doi:10.1136/bmjpo-2017-000105
(6) Slusher TM, Zipursky A, Bhutani VK. A global need for affordable neonatal jaundice technologies. Semin Perinatol. 2011;35(3):185-191. doi:10.1053/j.semperi.2011.02.014
(7) National Collaborating Centre for Women’s and Children’s Health. Neonatal Jaundice: NICE; 2010.