Has your baby turned into a "minion"? The truth and misunderstanding of neonatal jaundice

Author: Gao Hong, deputy chief nurse of the Second Affiliated Hospital of University of South China

Zhu Lulan Deputy Chief Nurse, Second Affiliated Hospital of University of South China

Li Qian The Second Affiliated Hospital of South China University

Tan Jia The First Affiliated Hospital of Nanhua University

Reviewer: Cai Zemin, Chief Physician, First Affiliated Hospital of University of South China

As the saying goes, "Nine out of ten babies have jaundice". Neonatal jaundice is common in newborn babies. Most people think it is a "normal phenomenon" or a "natural phenomenon", especially some elderly people may say: "Your brothers and sisters all had jaundice after birth, it's okay, you all grow up healthy now". But is this view really correct? Is neonatal jaundice serious? How should we correctly view neonatal jaundice?

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Neonatal jaundice, also known as neonatal hyperbilirubinemia, is a symptom of yellowing of the skin, mucous membranes, and sclera caused by increased bilirubin in the blood of newborns. About 80% of newborns will have yellowing of the skin and mucous membranes in the early period after birth [1]. However, the causes of jaundice are numerous and complex, and the severity of the disease varies. Severe cases can cause bilirubin encephalopathy, resulting in permanent damage to the nervous system or even death.

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1. Why do newborn babies have jaundice?

Bilirubin in human blood is generally in a state of dynamic equilibrium, that is, its production and excretion are basically equal. Any reason that causes an increase in bilirubin production or a decrease in excretion or both at the same time may induce an increase in bilirubin in the blood, resulting in jaundice. Newborn babies have more red blood cells, but their life span is short, so a large number of red blood cells will release bilirubin after being destroyed, increasing the level of bilirubin in the blood.

2. Do all neonatal jaundice require hospitalization?

No. Neonatal jaundice is divided into physiological jaundice and pathological jaundice. Physiological jaundice does not require treatment. It is a physiological phenomenon in the neonatal period and can disappear on its own. Pathological jaundice requires prompt medical treatment.

3. How to distinguish whether neonatal jaundice is physiological jaundice or pathological jaundice?

There are four main points of physiological jaundice, as follows:

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However, when neonatal jaundice has any of the following characteristics, parents should consider the possibility of pathological jaundice and go to the hospital in time and leave it to a professional doctor to make a judgment.

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4. What tests are needed if the baby has neonatal jaundice?

Auxiliary examinations for neonatal jaundice are generally divided into blood tests, transcutaneous jaundice meter measurement, imaging examinations and visual observation of jaundice.

1. Blood test

(1) Serum bilirubin measurement: It is the "gold standard" for determining whether neonatal jaundice requires intervention.

(2) Blood routine test: used to determine whether jaundice is caused by polycythemia.

(3) Glucose-6-phosphate dehydrogenase (G6PD) assay: used to determine whether jaundice is caused by G6PD deficiency.

(4) Blood type identification + hemolysis test: used to determine whether jaundice is caused by ABO hemolysis or Rh hemolysis.

2. Transcutaneous jaundice measurement

The commonly used measurement sites for transcutaneous jaundice measurement are the forehead and chest. This detection method is non-invasive and easy to operate, but the measurement error is large and sometimes it cannot accurately reflect the concentration of bilirubin in the baby's blood. It is often used for screening of neonatal jaundice and as a reference when the baby is not suitable for blood drawing.

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3. Imaging examination

(1) Ultrasound and abdominal X-ray: mainly used to determine whether there is a surgical cause.

(2) Magnetic resonance imaging of the head: helps determine whether bilirubin encephalopathy occurs.

4. Visual Detection of Jaundice

Visual inspection is a simple way to judge the degree of jaundice, and parents can use this method to make a preliminary judgment. This method is only a rough evaluation method, and each person's subjective judgment of color is inconsistent, so there is an error.

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5. If the baby has physiological jaundice, how should parents take care of the baby?

When you find that your baby has turned into a "yellow man" not long after birth, parents should not worry too much. Physiological jaundice is a physiological phenomenon and does not require special treatment. Continue to breastfeed your baby to keep the baby's bowel movements smooth, but parents should continue to observe the progress of the yellowing of the skin.

6. How should we treat and care for our baby if he or she has pathological jaundice?

1. Blue light therapy and care

Blue light therapy is the most common and effective method for treating neonatal jaundice in clinical practice. Blue light therapy uses light-oxidation to convert fat-soluble unconjugated bilirubin in the baby's body into water-soluble conjugated bilirubin, which is excreted from the body through urine or feces, thereby reducing jaundice and its effects on the body.

During the blue light therapy, the nurse will use a blue light blocking eye mask to protect the baby's eyes, cover the baby's reproductive parts with a blue light blocking diaper, and observe the baby's every move at any time to ensure safety.

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2. Medication

(1) Liver enzyme inducers: They can increase the ability of hepatocytes to take up free bilirubin, thereby enhancing the liver's ability to clear bilirubin.

(2) Albumin: Increasing the binding between bilirubin and albumin can reduce the free bilirubin in the blood.

(3) 5% sodium bicarbonate: It can increase the pH value of blood, which is beneficial for the binding of unconjugated bilirubin to albumin.

Intravenous immunoglobulin (IVIG): It is used when hemolytic disease of the newborn is confirmed to slow the progression of hemolysis.

3. Exchange blood therapy

Don’t be afraid of “transfusion”, in fact, transfusion therapy is a life-saving measure for babies with severe jaundice. It can quickly reduce the baby’s jaundice and block the damage of bilirubin to the brain.

7. Common misunderstandings about neonatal jaundice

Common misunderstanding 1: Nine out of ten babies have jaundice. No treatment is needed, and the jaundice will go away on its own. Don’t make a fuss!

Correct answer: Physiological jaundice is a normal phenomenon. Most mild jaundice has no obvious effect on the baby and can slowly disappear on its own. If it is pathological jaundice, untreated or delayed treatment can cause bilirubin encephalopathy and cause permanent brain damage.

Common misunderstanding 2: If your baby has jaundice, just let him get more sun, it’s not a big deal!

Correct answer: Sunlight also contains blue light, so sunbathing can also help reduce jaundice in babies. However, due to the limited skin exposure in the natural environment, the effect is not significant. In addition, there are ultraviolet rays in sunlight, and the skin of newborns is delicate and easily sunburned, so overall, the disadvantages outweigh the advantages.

Common misunderstanding 3: Baby’s jaundice is caused by breastfeeding and it will be fine if you stop breastfeeding for a few days!

Correct answer: There is a certain correlation between breastfeeding and neonatal jaundice, but breast milk jaundice is generally physiological jaundice. The general condition is good, no intervention is required, and it will not cause harm. Therefore, stopping breastfeeding in order to reduce jaundice is not worth the cost, so it is not recommended to stop breastfeeding.

Common misunderstanding 4: If your baby has jaundice, drinking more boiled water, sugar water, and urinating more often can reduce the jaundice!

Correct answer: As we all know, breast milk is the best source of nutrition for children. Newborns grow and develop rapidly and need adequate nutrition supply. The energy density of water and sugar water is low and single. Not only can they not meet the needs of children's growth and development, but they may also affect the normal intake of breast milk. The saying that "sugar water can reduce jaundice" has no scientific basis at present, so it is not recommended to feed children more boiled water and sugar water, but breastfeeding should be encouraged more.

Common misunderstanding 5: If your baby has jaundice, you can use home phototherapy to reduce the jaundice yourself!

Correct answer: Home phototherapy has strict standards and requires doctor's evaluation and confirmation. The effectiveness of home phototherapy depends on the quality of the phototherapy equipment and the ability to use the equipment appropriately. Home phototherapy is not recommended for newborns with any risk factors for bilirubin encephalopathy. For babies who meet the conditions for phototherapy, parents can choose daytime phototherapy implemented in regular hospitals, which can not only ensure safety and effectiveness, but also relieve the anxiety of mother-infant separation.

References:

[1] Wang Weiping, Sun Kun, Chang Liwen. Pediatrics (9th edition)[M]. Beijing: People's Medical Publishing House, 2018: 111.