Jaundice is a common condition in newborns, characterized by the yellowing of the skin and eyes. This condition occurs due to elevated levels of bilirubin in the blood. While jaundice is often benign and resolves without intervention, a subset of cases known as pathological jaundice requires prompt medical attention. Pathological jaundice can indicate underlying health issues and can lead to serious complications if left untreated. This article provides an in-depth exploration of pathological jaundice in newborns, discussing its causes, symptoms, diagnosis, and treatment.
Physiological vs. Pathological Jaundice
Newborn jaundice is classified into two main types: physiological and pathological. Understanding the distinction between these two forms is crucial for timely and appropriate medical intervention.
Physiological Jaundice
Physiological jaundice is the most common type, affecting about 60% of full-term and 80% of preterm infants. It typically appears within the first two to four days of life and resolves within two weeks without treatment. This type of jaundice is considered normal and occurs due to the immature liver of the newborn, which is not yet fully capable of processing bilirubin efficiently.
Pathological Jaundice
Pathological jaundice, on the other hand, manifests within the first 24 hours of life or persists beyond the usual timeframe of physiological jaundice. It may also involve higher levels of bilirubin than what is typical for physiological jaundice. Pathological jaundice can result from various underlying conditions, and early diagnosis and treatment are essential to prevent severe complications, such as kernicterus, a type of brain damage caused by excessive bilirubin.
Causes of Pathological Jaundice
Pathological jaundice can arise from several different conditions, each affecting the newborn’s ability to process and excrete bilirubin. Key causes include:
Hemolytic Diseases
Rh Incompatibility: This condition occurs when there is a blood type mismatch between the mother and the newborn, leading to the destruction of the infant’s red blood cells. This destruction releases a large amount of bilirubin, overwhelming the liver’s ability to process it.
ABO Incompatibility: Similar to Rh incompatibility, this occurs when the mother and baby have incompatible blood types (e.g., mother is type O and baby is type A or B), resulting in the breakdown of the newborn’s red blood cells.
Inherited Disorders
G6PD Deficiency: Glucose-6-phosphate dehydrogenase deficiency is an inherited enzyme disorder that can lead to the rapid breakdown of red blood cells in response to certain triggers, such as infections or certain medications, leading to jaundice.
Hereditary Spherocytosis: This genetic condition causes red blood cells to become misshapen and fragile, leading to their premature destruction and subsequent jaundice.
Infections
Congenital Infections: Infections acquired in utero, such as cytomegalovirus (CMV), rubella, or syphilis, can cause jaundice by damaging the liver or red blood cells.
Sepsis: Newborns with bacterial infections (sepsis) can develop jaundice as the infection affects liver function and increases the breakdown of red blood cells.
Liver and Biliary Disorders
Biliary Atresia: This condition involves the blockage or absence of bile ducts, preventing the normal flow of bile from the liver to the gallbladder and intestines, leading to the accumulation of bilirubin in the blood.
Neonatal Hepatitis: Inflammation of the liver in newborns can impair bilirubin processing and excretion, resulting in jaundice.
Metabolic Disorders
Galactosemia: This metabolic disorder impairs the body’s ability to process galactose, leading to liver damage and jaundice.
Hypothyroidism: Low thyroid hormone levels can slow down the processing of bilirubin, contributing to jaundice.
Symptoms of Pathological Jaundice
The primary symptom of jaundice is the yellowing of the skin and the whites of the eyes. However, in cases of pathological jaundice, additional symptoms may indicate the need for immediate medical evaluation:
1. Early Onset: Jaundice appearing within the first 24 hours of life is a red flag for pathological jaundice.
2. Prolonged Duration: Jaundice lasting more than two weeks in full-term infants and more than three weeks in preterm infants.
3. High Bilirubin Levels: Severe yellowing that extends beyond the face and chest to the lower abdomen, arms, and legs.
4. Poor Feeding: Difficulty in feeding or a lack of interest in feeding, which can exacerbate jaundice by reducing the elimination of bilirubin.
5. Lethargy: Excessive sleepiness or difficulty in waking the baby for feeds.
6. Dark Urine and Pale Stools: These can indicate that bilirubin is not being properly excreted.
7. High-Pitched Cry: An unusual, high-pitched cry can be a sign of neurological involvement due to high bilirubin levels.
Diagnosis of Pathological Jaundice
Accurate diagnosis of pathological jaundice involves a combination of clinical assessment and laboratory tests:
Clinical Assessment
Physical Examination: The healthcare provider examines the newborn for the extent and severity of jaundice, paying attention to the timing of onset and any associated symptoms.
Medical History: A thorough review of the mother’s pregnancy and delivery history, as well as any family history of jaundice or hemolytic diseases, is essential.
Laboratory Tests
Bilirubin Levels: Total serum bilirubin (TSB) levels are measured to determine the severity of jaundice. High levels of bilirubin indicate a need for further investigation.
Blood Type and Coombs Test: These tests help identify blood type incompatibilities and the presence of antibodies that may be causing hemolysis.
Complete Blood Count (CBC): This test provides information on the baby’s red blood cell count and hemoglobin levels, which can indicate hemolysis or other underlying conditions.
Liver Function Tests: These tests assess the liver’s ability to process and excrete bilirubin, identifying any hepatic dysfunction.
Peripheral Blood Smear: This test can reveal abnormalities in the shape and size of red blood cells, pointing to conditions like hereditary spherocytosis.
Treatment of Pathological Jaundice
The treatment of pathological jaundice depends on the underlying cause and the severity of the condition. The primary goals are to reduce bilirubin levels and address the root cause of jaundice. Key treatment options include:
Phototherapy
Phototherapy is the most common treatment for jaundice. It involves exposing the baby’s skin to special blue spectrum lights, which convert bilirubin into a form that can be more easily excreted in the urine and stool. Phototherapy is highly effective and usually reduces bilirubin levels within a few days.
Exchange Transfusion
In severe cases where bilirubin levels are dangerously high, an exchange transfusion may be necessary. This procedure involves removing small amounts of the baby’s blood and replacing it with donor blood to rapidly lower bilirubin levels and prevent complications like kernicterus.
Medications
Intravenous Immunoglobulin (IVIg): In cases of hemolytic disease due to blood type incompatibility, IVIg can reduce the destruction of red blood cells and lower bilirubin levels.
Phenobarbital: This medication can enhance liver enzyme activity and improve bilirubin processing in certain conditions.
See Also: What Are the Dangers of Jaundice in Newborns?
Surgery
For conditions like biliary atresia, surgical intervention is often required to create a pathway for bile to drain from the liver to the intestine, alleviating jaundice and preventing liver damage.
Managing Underlying Conditions
Treating Infections: Antibiotics or antiviral medications may be necessary to treat underlying infections causing jaundice.
Managing Metabolic Disorders: Specific dietary modifications and medications are required to manage metabolic disorders like galactosemia and hypothyroidism.
Prevention and Prognosis
Preventing pathological jaundice involves careful monitoring and early intervention, especially in newborns with known risk factors. Key preventive measures include:
Prenatal Care: Regular prenatal care can identify and manage conditions that may lead to jaundice, such as Rh incompatibility.
Early Feeding: Frequent and adequate breastfeeding or formula feeding can promote bilirubin excretion and prevent severe jaundice.
Monitoring: Newborns at risk of jaundice, such as those with a family history of hemolytic disease, should be closely monitored for early signs of jaundice.
The prognosis for newborns with pathological jaundice depends on the underlying cause and the timeliness of treatment. With prompt and appropriate intervention, most infants recover fully without long-term complications. However, untreated or severe cases of pathological jaundice can lead to serious outcomes, including:
Kernicterus: This rare but severe form of brain damage can result from very high levels of bilirubin. It can cause permanent neurological damage, including hearing loss, intellectual disability, and motor dysfunction.
Liver Damage: Conditions like biliary atresia and neonatal hepatitis, if not treated, can lead to chronic liver disease and the need for liver transplantation.
Conclusion
Pathological jaundice in newborns is a serious condition that requires prompt diagnosis and intervention. Understanding the causes, symptoms, and treatment options is crucial for healthcare providers and parents alike. With early and appropriate care, the majority of newborns with pathological jaundice can achieve a full recovery and lead healthy lives. Continued research and advancements in neonatal care are essential to improve outcomes and prevent complications associated with this condition.
