Jaundice

Jaundice

Jaundice is a yellow coloring of the eyes and skin. This yellow coloring is the result of a buildup of a chemical in the blood called bilirubin. It is a common symptom in newborn babies and is usually not a sign of serious illness. In older children, it can be a sign of a liver disease or a blood disorder.

Jaundice should not be confused with carotenemia, which is an orange- yellow coloring in the skin caused by too much carotene in the diet. Carotene is a natural food coloring found in fruits and vegetables that have a lot of Vitamin A. It is the natural chemical in plants that causes them to be yellow or orange. The easiest way to tell if a child has carotenemia instead of jaundice is to look at the white part of his eyes. If the child is jaundiced, the white part of the eyes will also be yellow, but with carotenemia, the white parts stay white. The bottom line is if the white part of your child's eyes look yellow, you should contact his pediatrician or family practitioner for an evaluation.

There are a lot of causes of excess bilirubin (hyperbilirubinemia) in the blood. If left untreated, most of the time the bilirubin with continue to increase slightly but will not reach dangerous levels. However, in some cases the bilirubin will continue to increase and can then act like a poison (toxin) to the nervous system, especially the brain. This is called kernicterus and can lead to deafness, seizures, or developmental delay. Fortunately kernicterus is rare because hyperbilirubinemia is usually easy to monitor and treat before dangerous blood levels are reached.

How does bilirubin get in the blood?

Bilirubin in a natural breakdown product of blood cells. Everyday, old red blood cells are destroyed and replaced with new ones. Each red blood cell lives about 120 days. Usually the rate of destruction and creation are in balance so that the amount of bilirubin from the destroyed blood cells is kept under control by the liver, which serves to clear bilirubin from the blood stream. Bilirubin is then taken up into the liver where it is converted (conjugated) to another form that is then excreted into the gut. This conjugated bilirubin is then broken down by bacteria and is what gives stool its brown to green coloring. Conjugated bilirubin can also be broken down again into an unconjugated form that reenters the blood stream.

If the body suddenly starts destroying red blood cells (a condition called hemolysis) faster than the liver can clear the bilirubin from the blood, the result can be hyperbilirubinemia and a yellow-orange coloring will be seen in the eyes and skin. Another way that bilirubin can accumulate in the body is if the liver is not working properly because of infection or some other condition and the conjugated bilirubin is not getting released into the intestine. This is called cholestasis. Again, the skin and eyes will get a yellow color, and sometimes the bowel movements with be white or clay colored instead of brown, green or yellow.

There are some simple blood tests that can help doctors tell these two types of hyperbilirubinemia apart. One blood test measures the total amount of bilirubin in the blood and the other measures the bilirubin that has been conjugated. The difference between these two measurements is used to calculate the unconjugated bilirubin. Another method used to measure total bilirubin in the blood uses a device held onto the skin and does not require a needle stick. The drawback to this method is that is can only be used as a screening tool and cannot replace the blood test in infants whose jaundice is getting worse.

In very young babies, jaundice is quite common. Most often the cause is physiologic, meaning it is not related to hemolysis or cholestasis, but rather to the slow transition of getting bilirubin cleared via the liver rather than the placenta once the baby is delivered. This type of jaundice usually first appears in the second or third day of life and peaks within the first week of life. The total level seldom reaches an amount worth getting concerned about or requiring treatment.

Other causes can be Breastfeeding jaundice or breast milk jaundice (see below). Breastfeeding jaundice and breast milk jaundice are two other types of hyperbilirubinemia in infants. Breast feeding jaundice describes the fact that breast-fed babies with physiologic jaundice generally reach higher levels of total bilirubin compared to formula-fed babies. There are many theories why this is the case, but regardless, even breast-fed babies with physiologic jaundice seldom get high enough levels of bilirubin to cause any problems. Breastmilk jaundice, on the other hand, usually appears during the second to third week of life and is believed to be caused by a hormone in breastmilk that interferes with the natural elimination of bilirubin. Some babies with breastmilk jaundice may get levels of bilirubin high enough to warrant treatment. Since it has been demonstrated that stopping breast-feeding for just twenty-four hours can dramatically decrease the level of bilirubin in the blood, some doctors advocate having the mother stop breast-feeding for a day if breastmilk jaundice is a concern. Others do not recommend this practice because they believe it causes mothers to quit breast-feeding too soon out of concern that there is "something wrong" with their milk.

Although most causes of jaundice in babies are benign and don't require treatment, newborns can also have hemolysis or cholestasis as a cause of their jaundice. For example, if the mother's blood is a different type than her baby's, she can pass antibodies against the baby's blood across the placenta to the baby. These antibodies can attack the baby's red blood cells and cause them to break down rapidly. Because there are many potential causes of jaundice in an infant, doctors pay close attention to newborns who show an excessive rise in bilirubin or a particularly lengthy course or if jaundice is found on the first day of life.

What are the treatments for jaundice?

Depending on the cause, the treatments may be fairly simple. In young infants with jaundice, the doctor will check the mother's blood type and the baby's blood type as well as a blood count to make sure that the jaundice is not related to hemolysis. She will also check both total and conjugated bilirubin in the baby's blood to determine if the cause could be related to cholestasis. If the blood tests are consistent with physiologic jaundice, the doctor may monitor the baby to see if the bilirubin levels are rising and may recommend that the baby get direct or indirect sunlight daily. If the bilirubin reaches a high enough level, the doctor may order that the baby be placed under special lights (phototherapy) to help bring down the level. But if the bilirubin continues to rise despite phototherapy, the baby may need a partial or complete blood exchange which is done in a hospital setting. This involves taking some of the baby's blood and replacing it with salt water (saline) or with someone else's blood (transfusion).

For patients with jaundice from cholestasis, treatment is aimed at the cause of the cholestasis. There is no danger of kernicterus in these patients, and they do not benefit from photo therapy. In fact, photo therapy in these patients can give them an odd bronze coloring (bronze baby syndrome) that takes a very long time to fade.

To learn more about specific causes of jaundice, please see the article about the specific disease or condition.