Icterus neonatorum

Definition

Jaundice in neonates is called icterus neonatorium

Jaundice phototherapy

Jaundice

Jaundice is yellowish appearance or discoloration in newborn infants

Cause

Jaundice happens when a chemical called bilirubin builds up in the baby’s blood.

Pathophysiology

During pregnancy, the mother’s liver removes bilirubin for the baby, but after birth the baby’s liver must remove the bilirubin. In some babies, the liver might not be developed enough to efficiently 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.

Consequences of untreated jaundice

When severe jaundice goes untreated for too long, it can cause a condition called kernicterus.

Kernicterus

Kernicterus is a type of brain damage that can result from high levels of bilirubin in a baby’s blood.

Atheroid cerebral palsy

It can cause athetoid cerebral palsy and hearing loss. Kernicterus also causes problems with vision and teeth and sometimes can cause intellectual disabilities. Early detection and management of jaundice can prevent kernicterus.

Signs and Symptoms

Jaundice usually appears first on the face and then moves to the chest, belly, arms, and legs as bilirubin levels get higher. The whites of the eyes can also look yellow. Jaundice can be harder to see in babies with darker skin color.

Diagnosis

• At a minimum, babies should be checked for jaundice every 8 to 12 hours in the first 48 hours of life.
• It is important for your baby to be seen by a nurse or doctor when the baby is between 3 and 5 days old, because this is usually when a baby’s bilirubin level is highest.
• This is why, if your baby is discharged before age 72 hours, your baby should be seen within 2 days of discharge.
• The timing of this visit may vary depending on your baby’s age when released from the hospital and other factors.

Tests

• A doctor or nurse may check the baby’s bilirubin using a light meter that is placed on the baby’s head. This results in a transcutaneous bilirubin (TcB) level. If it is high, a blood test will likely be ordered.
• The best way to accurately measure bilirubin is with a small blood sample from the baby’s heel.
• This results in a total serum bilirubin (TSB) level.
• If the level is high, based upon the baby’s age in hours and other risk factors, treatment will likely follow. Repeat blood samples will also likely be taken to ensure that the TSB decreases with the prescribed treatment.

Treatment

• No baby should develop brain damage from untreated jaundice.
• When being treated for high bilirubin levels, the baby will be undressed and put under special lights.
• The lights will not hurt the baby.
• This can be done in the hospital or even at home.
• The baby’s milk intake may also need to be increased.
• In some cases, if the baby has very high bilirubin levels, the doctor will do a blood exchange transfusion.
• Jaundice is generally treated before brain damage is a concern.
• Putting the baby in sunlight is not recommended as a safe way of treating jaundice.

Risk Factors

• About 60% of all babies have jaundice.
• Babies with any of the following risk factors need close monitoring and early jaundice manage­ment:

• Preterm Babies
• Babies born before 37 weeks, or 8.5 months, of pregnancy as the young liver might not be able to get rid of so much bilirubin.
• Babies with Darker Skin Color
• East Asian or Mediterranean Descent
• A baby born to an East Asian or Mediterranean family
• G6PD deficiency
• Feeding Difficulties
• Sibling with Jaundice
• Bruising
• Blood Type
• Women with an O blood type or Rh negative blood factor might have babies with higher bilirubin levels.
• A mother with Rh incompatibility should be given Rhogam.

CDC recommendations

• Promote and support successful breastfeeding.
• Establish nursery protocols for the identification and evaluation of hyperbilirubinemia.
• Measure the total serum bilirubin (TSB) or transcutaneous bilirubin (TcB) level on infants jaundiced in the first 24 hours.
• Recognize that visual estimation of the degree of jaundice can lead to errors, particularly in darkly pigmented infants.
• Interpret all bilirubin levels according to the infant’s age in hours.
• Recognize that infants at less than 38 weeks’ gestation, particularly those who are breastfed, are at higher risk of developing hyperbilirubinemia and require closer surveillance and monitoring.
• Perform a systematic assessment on all infants before discharge for the risk of severe hyperbilirubinemia.
• Provide parents with written and verbal information about newborn jaundice.
• Provide appropriate follow-up based on the time of discharge and the risk assessment.
• Treat newborns, when indicated, with phototherapy or exchange transfusion

ICD

ICD10:P58 , P59

ICD9:773 , 774

Icterus neonatorum Resources
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