Jaundice, also known as hyperbilirubinemia, is defined as a yellow discoloration of the body tissue resulting from the accumulation of excess bilirubin. Jaundice can occur in any of the three phases in bilirubin production(before, during and after) both in newborn and adults.
Neonatal jaundice
Newborn jaundice, also known as neonatal jaundice, is simply the yellow discoloration of a baby’s skin and eyes. The liver processes bilirubin, which passes through the intestinal tract but a newborn’s developing liver may not be mature enough to remove bilirubins. Newborn jaundice usually goes away on its own (two to three weeks) as a baby’s liver develops and as the baby begins to feed, which helps bilirubins pass through the body.
It is, however, worth of note that high levels of bilirubin can put a baby at risk of deafness, cerebral palsy, and other forms of brain damage (kernicterus) which is why The American Academy of Paediatrics (AAP) recommends that all newborn babies be examined for jaundice before discharge from the hospital and again when the baby is between 3 and 5 days old.
Symptoms of Neonatal Jaundice
The symptoms of jaundice in a newborn include; yellow discoloration of the skin, mucous membranes and the whites of the eyes, light-colored stool, poor feeding, lethargy/excessive sleepiness, changes in muscle tone (either listless or stiff with arching of the back), high-pitched crying, and seizures.
The types/causes of neonatal jaundice
Physiologic jaundice
This type is usually evident on the second or third day of life and is usually a transient and harmless condition. Physiologic jaundice is caused by the inability of the newborn’s immature liver to metabolise (conjugate) and thus excrete bilirubin, which accumulates due to the breakdown of red blood cells which have a shorter life-span (70 to 90 days) than adult red blood cells (120 days).
Maternal-foetal blood group incompatibility (Rh, ABO)
This type of jaundice occurs when there is incompatibility between the blood types of the mother and the foetus. The bilirubin levels increase from the breakdown of the foetus’ red blood cells (hemolysis).
Breast milk jaundice
This occurs in breastfed newborns and often appears at the end of the first week of life. It is believed certain chemicals in the breast milk are responsible. This condition resolves spontaneously and mothers typically do not have to discontinue breastfeeding.
Breastfeeding jaundice
This happens when a breastfed newborn does not receive adequate breast milk due to delayed or insufficient milk production by the mother or poor feeding by the newborn.
This inadequate intake results in dehydration and fewer bowel movements for the newborn, which in turn results in decreased bilirubin excretion from the body.
Cephalohematoma (a collection of blood under the scalp)
Sometimes during the birthing process, a baby may sustain a bruise or injury to the head, which leads to blood collection/blood clot under the scalp. As this blood is naturally broken down, sudden elevated levels of bilirubin may overwhelm the processing capability of the newborn’s immature liver, resulting in jaundice.
Red blood cell enzyme defects
Inherited genetic enzyme disorders, like glucose-6-phosphate dehydrogenase deficiency (G6PD deficiency) or pyruvate kinase deficiency, can lead to increased hemolysis and subsequent elevation in bilirubin levels.
Red blood cell membrane defects
Abnormalities in the membrane and shape of red blood cells like spherocytosis, can lead to increased hemolysis.
Other causes of neonatal jaundice include prematurity, maternal diabetes, polycythemia, infection/sepsis, hypothyroidism, biliary atresia, cystic fibrosis, Crigler-Najjar syndrome, Gilbert syndrome, hepatitis, thalassemia, and galactosemia.
Treatment for neonatal jaundice
It is common for Nigerian mothers and grandmothers to recommend the use of paw paw water to treat jaundice. This has however been debunked and several experts warn against it.
The proper treatment for neonatal jaundice is phototherapy. This is a treatment with a special type of light (not sunlight) to make it easier for the baby’s liver to break down and remove the bilirubin from their blood.
Phototherapy aims to expose the baby’s skin to as much light as possible. The baby will be placed under a light either in a cot or incubator with their eyes covered. This is usually stopped for 30 minutes to enable the mother to feed her baby, change their diaper and give them a cuddle.
Jaundice in Adult
Jaundice in an adult is caused by a variety of medical conditions like hepatitis, gallstones and tumours. Some of these conditions are serious and potentially life-threatening.
An adult who develops jaundice needs to undergo a comprehensive medical evaluation in order to determine its cause.
Causes/types of Jaundice in Adults
Jaundice is rare in adults but can be caused by a problem in any of the three phases in bilirubin production.
Before the production of bilirubin, we have unconjugated jaundice which is due to increased levels of bilirubin. This is caused by the reabsorption of a large hematoma (a collection of clotted or partially clotted blood under the skin), or hemolytic anemias (blood cells are destroyed and removed from the bloodstream before their normal lifespan is over).
During the production of bilirubin, jaundice can be caused by viruses, including Hepatitis A, chronic Hepatitis B and C, and Epstein-Barr virus infection (infectious mononucleosis), alcohol, autoimmune disorders, rare genetic metabolic defects, and medicines, including acetaminophen toxicity, penicillins, oral contraceptives, chlorpromazine and estrogenic or anabolic steroids.
After bilirubin production, jaundice can be caused by obstruction of the bile ducts from gallstones, inflammation of the gallbladder, gallbladder cancer or pancreatic tumour.
Symptoms of Jaundice
The symptoms of jaundice can go unnoticed as it may not be severe. The severity of symptoms depends on the underlying cause and how quickly or slowly the disease develops.
For short-term cases of jaundice which is usually caused by infection, the symptoms include; fever, chills, abdominal pain, flu-like symptoms, change in skin colour, dark-colored urine or clay-colored stool.
For jaundice not caused by an infection, you can have symptoms like weight loss or itchy skin (pruritus). If the jaundice is caused by pancreatic or biliary tract cancers, the most common symptom is abdominal pain.
You can have jaundice occurring with liver disease if you have chronic hepatitis or inflammation of the liver, pyoderma gangrenosum (a type of skin disease), acute hepatitis A, B or C, and polyarthralgias (inflammation of the joints).
How is jaundice diagnosed?
Jaundice is diagnosed by checking for signs of liver disease by bruising the skin, spider angiomas (abnormal collection of blood vessels near the surface of the skin), or palmar erythema (red coloration of the palms and fingertips).
Conjugated jaundice is diagnosed through urinalysis (urine testing). The findings of urinalysis however should be confirmed by serum testing. The serum testing includes a complete blood count (CBC) and bilirubin levels.
An exam to determine the size and tenderness of your liver will also be carried out by your doctor using imaging (ultrasonography and computed tomography (CT) scanning) and liver biopsy (taking a sample of the liver) to further confirm diagnosis.
Treatment
Jaundice treatment here depends on the underlying cause of jaundice. Jaundice can lead to itching or pruritis which can be relieved through warm baths containing oatmeal and the use of antihistamines for mild pruritus or other medication prescribed by a health professional.
Seeing jaundice may sometimes indicate a problem with the liver, a liver transplant may be necessary in some cases.
NOTE: Jaundice is liver related, hence the need to care for your liver.
