Patient's question:
My baby is 14 days old. The doctor said my baby had jaundice at birth and has been under treatment, but it's still a bit yellow today. The jaundice level is above 4. What should I do? What methods can help reduce my baby's jaundice?Doctor's answer:
Hello: Neonatal pathological jaundice is different from physiological jaundice and can be distinguished based on its characteristics. Neonatal pathological jaundice is a group of diseases composed of many causes. Common causes of jaundice include hemolytic jaundice, infectious jaundice, obstructive jaundice, breast milk jaundice, etc. Jaundice caused by different reasons has different characteristics.(1) Hemolytic jaundice: The most common cause of hemolytic jaundice is ABO incompatibility, which is caused by the blood type mismatch between the mother and the fetus. The most common cases are when the mother's blood type is O and the fetus's blood type is A or B, resulting in more severe jaundice. Other cases, such as when the mother's blood type is A and the fetus's blood type is B or AB, or when the mother's blood type is B and the fetus's blood type is A or AB, are less common and result in milder jaundice. As a result, some parents may become very anxious, worrying that their child will develop ABO hemolytic jaundice. However, it should be noted that not all newborns with ABO blood type incompatibility will develop hemolysis. It is reported that the incidence rate of ABO hemolytic jaundice in newborns is 11.9%. The characteristics of neonatal hemolytic jaundice are the appearance of jaundice within 24 hours after birth and gradual worsening.
(2) Infectious jaundice: Infectious jaundice is caused by viral or bacterial infections that primarily damage liver cell function. Viral infections are often congenital and the most common are cytomegalovirus and hepatitis B virus infections. Other infections, such as rubella virus, EB virus, and toxoplasma, are less common. Bacterial infections are most commonly seen in sepsis jaundice. The characteristics of jaundice are the persistence of jaundice without resolution after physiological jaundice or the reappearance and progression of jaundice after the resolution of physiological jaundice.
(3) Obstructive jaundice: Obstructive jaundice is often caused by congenital biliary malformations, with congenital biliary atresia being the most common. The characteristics of jaundice are the reappearance of jaundice 1-2 weeks or 3-4 weeks after birth, gradually worsening, and the stool color gradually changing to a pale yellow or even a clay-like white.
(4) Breast milk jaundice: This is a special type of pathological jaundice. In a small number of breastfed newborns, the degree of jaundice exceeds normal physiological jaundice, though the exact cause is not yet fully understood. The characteristics of jaundice are that after the peak of physiological jaundice, jaundice continues to worsen, with bilirubin levels reaching 10-30 mg/dL. If breastfeeding continues, jaundice remains at a high level for a period before gradually declining. If breastfeeding is stopped for 48 hours, bilirubin levels drop significantly by 50%. If breastfeeding resumes, bilirubin levels rise again.
Regardless of the cause, severe pathological jaundice can lead to "kernicterus," with poor prognosis. It can cause neurological damage and, in severe cases, lead to death. Therefore, prevention is key for neonatal pathological jaundice, such as preventing toxoplasma and rubella virus infections during pregnancy, especially in the early stages, preventing sepsis after birth, and administering hepatitis B vaccines at birth. Parents should closely monitor their child's jaundice changes and seek medical attention promptly if signs of pathological jaundice are observed.
Newborns can develop physiological jaundice shortly after birth, usually appearing 2-3 days after birth, peaking 4-6 days later, and beginning to subside 7-10 days after birth. Apart from poor appetite, it has no significant impact on the child. If jaundice appears within 24 hours of birth and does not resolve within 3 weeks, or if it reappears after resolution, it is classified as pathological jaundice.
Normal blood test values are: total bilirubin 3.4-17.1 μmol/L (0.2-1.0 mg/dL), direct bilirubin 0.50-3.4 μmol/L (0.03-0.2 mg/dL).
Clinical symptoms of neonatal pathological jaundice include: jaundice appearing early (within 24 hours); severe jaundice with yellowing of the hands and feet, with serum bilirubin levels greater than 205 μmol/L; jaundice that resolves and then reappears or worsens rapidly, with serum bilirubin levels increasing by more than 85.5 μmol/L daily; prolonged jaundice, lasting longer than 2 weeks in full-term infants and more than 4 weeks in preterm infants.
Overview of the Disease
Jaundice is more common in newborns than in any other age group. Its causes are specific and complex, including both physiological jaundice, pathological jaundice, and breast milk jaundice. These conditions should be differentiated and treated accordingly. If a child develops jaundice within 24 hours of birth or if jaundice progresses rapidly, lasts for a long time, or is accompanied by anemia, abnormal body temperature, poor feeding, vomiting, or abnormal stool and urine color, it is often pathological jaundice. Common causes of pathological jaundice include neonatal hemolytic disease, neonatal infections, biliary malformations, and neonatal hepatitis.
Description of the Disease
Jaundice is a common clinical symptom in the neonatal period. Due to different pathogenesis, it can be either a physiological phenomenon or a pathological one. Clinically, if the serum total bilirubin level exceeds 205.2 μmol/L (12 mg/dL) in full-term infants or 256.5 μmol/L (16 mg/dL) in preterm infants, it is referred to as hyperbilirubinemia.
Symptoms and Signs
Jaundice often appears within 24 hours after birth and lasts for more than 2 weeks (more than 3 weeks in preterm infants). It may disappear and then reappear, progressively worsening. Severe jaundice can be accompanied by kernicterus. In addition, due to different causes, jaundice is often accompanied by symptoms of the underlying disease.
Etiology
It is important to understand the mother's pregnancy and delivery history, including any infections or medication use before delivery, blood transfusion history, and liver disease or jaundice history in family members. Pay attention to the gestational order, whether the child is premature, any birth injuries, asphyxia, hypoxia, hunger, or infection history. Detailed inquiries should be made about the onset and duration of jaundice, its severity and changes, and the color of stool and urine. Additionally, inquire about any medication use after birth that could cause jaundice (e.g., sulfonamides, salicylate preparations, high-dose vitamin K3 and K4) and exposure to naphthalene (e.g., mothballs).
Diagnostic Tests
(1) Complete blood count, reticulocyte count, and nucleated red blood cell count.
(2) Measurement of total and direct bilirubin. If serum bilirubin levels reach 205 μmol/L (12 mg/dL) in full-term infants or 256 μmol/L (15 mg/dL) in preterm infants, caution should be taken for the risk of bilirubin encephalopathy.
(3) Urinalysis and urine bile acid test.
(4) Observe stool and urine color; if necessary, perform a fecal urobilinogen test.
(5) Select the following tests based on the condition:
① For suspected neonatal hepatitis, perform liver function tests and check maternal and infant HBsAg, HBeAg, HBV DNA, anti-HBc IgM, and alpha-fetoprotein (normal newborns have positive alpha-fetoprotein, which turns negative one month after birth).
② For suspected neonatal sepsis, perform blood culture and smear and culture of local infection exudates.
③ For suspected cytomegalovirus inclusion disease, perform urine sediment tests to find inclusion-bearing giant cells. If possible, perform viral isolation and serological tests.
④ For suspected neonatal hemolysis, perform relevant tests; see neonatal hemolysis for details.
⑤ For suspected G6PD deficiency, measure the methemoglobin reduction rate (normal >75%, reduced in patients); Heinz body generation test; if possible, perform G6PD activity tests.
⑥ For suspected hereditary spherocytosis, perform red blood cell fragility tests (normal red blood cells begin to hemolyze at 0.40%-0.46% and completely hemolyze at 0.30%-0.36%, while patients have increased red blood cell fragility).
⑦ For suspected galactosemia, perform Benedict's test on urine; if possible, measure blood galactose levels and red blood cell galactose-1-phosphate uridyltransferase activity.
⑧ For suspected α1-antitrypsin deficiency, perform serum protein electrophoresis (α1-globulin