Patient's question:
Baby External Use for JaundiceThe baby in sister's family has just completed the full moon, and in recent days, she has noticed a lot of jaundice. She doesn't know what's going on either. We are all very anxious because the child is too young and doesn't dare to use medicine, so she came to consult the experts about what the cause of the baby's jaundice is?
Doctor's answer:
Jaundice is the most common symptom in newborns, and the causes of neonatal jaundice include the following:1. Physiological Jaundice
Physiological jaundice is a phenomenon unique to the neonatal period. Due to the low oxygen environment in the womb, the fetus produces excessive red blood cells, most of which are immature and easily destroyed. After birth, this leads to an overproduction of bilirubin, approximately twice that of adults. On the other hand, the liver of a newborn is immature, limiting bilirubin metabolism, which results in jaundice.
- Full-term infants: Physiological jaundice typically begins on the 2nd or 3rd day, with the skin turning a light yellow and the sclera (white part of the eyes) appearing predominantly blue with a slight yellow tint. The urine is slightly yellow but does not stain the diapers. The jaundice is most pronounced on the 4th or 5th day and usually disappears between the 10th and 14th day. Liver function tests are normal, and serum unconjugated bilirubin levels are elevated.
- Premature infants: Physiological jaundice appears earlier, is more severe, and persists longer, potentially lasting for 3 to 4 weeks. Although the child may appear uncomfortable, their general condition is usually good. Physiological jaundice is a normal physiological process and does not require treatment.
2. Breast Milk Jaundice
Jaundice caused by breastfeeding is called breast milk jaundice, a special type of pathological jaundice. In some breastfed newborns, the jaundice is more severe than the normal physiological level, though the exact cause is not fully understood. The characteristics of breast milk jaundice include:
- The jaundice worsens after the peak of physiological jaundice.
- If breastfeeding continues, the jaundice remains high for a period before gradually declining.
- If breastfeeding is stopped for 48 hours, the jaundice significantly decreases.
- If breastfeeding resumes, the jaundice rises again.
Breast milk contains progesterone, which inhibits the activity of glucuronosyltransferase in the newborn's liver, preventing bilirubin from being metabolized and excreted. This leads to increased bilirubin levels in the blood, causing yellowing of the skin and sclera. Breast milk jaundice generally does not affect the child's health and does not cause fever or poor appetite. If breastfeeding is stopped promptly, the jaundice usually improves within 2 to 4 days and disappears entirely within 6 to 10 days. Breast milk jaundice rarely causes neurological harm, so there is no need to panic. Breastfeeding can be temporarily replaced with formula milk during treatment, and breastfeeding can resume once the jaundice improves.
3. Hemolytic Jaundice
The most common cause of hemolytic jaundice is ABO incompatibility, which occurs when the mother and fetus have incompatible blood types. The most frequent case is when the mother is type O and the fetus is type A or B, resulting in more severe jaundice. Other cases, such as the mother being type A and the fetus being type B or AB, or the mother being type B and the fetus being type A or AB, are less common and cause milder jaundice. According to reports, the incidence of ABO incompatibility-induced hemolytic jaundice in newborns is 11.9%.
The characteristics of hemolytic jaundice include the appearance of jaundice within 24 hours after birth, which gradually worsens. Early treatment may involve blood exchange therapy. For mild ABO incompatibility symptoms, phototherapy is usually sufficient.
4. Infectious Jaundice
Infectious jaundice occurs when liver cell function is damaged due to viral or bacterial infections. Viral infections are often congenital, with cytomegalovirus and hepatitis B virus being the most common. Other infections, such as rubella virus, EB virus, and toxoplasmosis, are less frequent. Bacterial infections, particularly sepsis jaundice, are also common. The characteristics of infectious jaundice include the persistence of jaundice after physiological jaundice or the recurrence of jaundice after it has resolved.
5. Obstructive Jaundice
Obstructive jaundice is often caused by congenital biliary malformations, with congenital biliary atresia being the most common. The characteristics of obstructive jaundice include the reappearance of jaundice 1 to 2 weeks or 3 to 4 weeks after birth, which gradually worsens. The stool color may gradually turn light yellow or even clay-like. This type of jaundice can usually be diagnosed with an ultrasound.
Additionally, drug-induced jaundice can occur, such as that caused by vitamin K3, K4, or neomycin. Genetic diseases such as G6PD deficiency, pyruvate kinase deficiency, spherocytosis, galactosemia, α1-antitrypsin deficiency, and cystic fibrosis can also cause jaundice.
Regardless of the cause, severe pathological jaundice can lead to "kernicterus," with poor prognosis. This can cause neurological damage and, in severe cases, death. Therefore, prevention is key, such as avoiding toxoplasmosis and rubella infections during pregnancy, especially in the early stages, preventing sepsis after birth, and administering hepatitis B vaccines at birth.
It is important to closely monitor the child's jaundice. If signs of pathological jaundice appear, seek medical attention immediately. Do not panic or rush when dealing with jaundice in infants. If it is physiological, it will naturally subside. If it is pathological, prompt treatment is necessary. Careful observation and proper care are essential.