Today I'm sending my four days old baby to a clinic and have some blood test because we found a yellowish colour on his skin. I've been taught that it's a normal condition that will happen to a new born baby. But what I taught was wrong. And I've learn more about this symptom: Neonatal Jaundice.
What is Neonatal Jaundice?
Jaundice is apparent clinically when the level of bilirubin in the serum rises above
85μmol/l (5mg/dl). Physiological jaundice is a reflection of the bilirubin load to the liver, rate of hepatic excretion (liver maturity) and ability of the serum binding rotein to retain the bilirubin within the plasma.
And from the lab test at the clinic, my baby got 215μmol/l and considered as a serious Jaundice. Another blood test to be conduct tomorrow, if the reading increases, then my baby will need to have a hospital management. I pray to god that he will be okay by tomorrow.
What can go wrong in jaundice?
Elevated serum bilirubin can result in kernicterus, when unconjugated bilirubin is deposited in the cell wall of neurons in basal ganglia, brain stem and cerebellum resulting in cell death. Kernicterus is associated with a high mortality, and survivors usually suffer sequelae like athetoid cerebral palsy, high frequency hearing loss,paralysis of upward gaze and dental dysplasia. The factors influencing bilirubin toxicity in the brain cells of the neonate are complex and incompletely understood. There is no specific level of total serum bilirubin above which kernicterus can be predicted to happen.
When should a neonate be referred for hospital management? (When to worry?)
The following are indications for referral.
1. Jaundice below umbilicus, corresponding to serum bilirubin of 12-15 mg/dl (200-250 μmol/L).
2. Jaundice up to level of the sole of the feet - likely to need exchange transfusion.
3. Jaundice within 24 hours of life.
4. Rapid rise of serum bilirubin of more than 8.5 μmol/L/hour (>0.5 mg/dl/hour).
5. Prolonged jaundice of more than 14 days - other causes/conditions need to be excluded e.g. neonatal hepatitis, biliary atresia.
6. Family history of significant haemolytic disease or kernicterus
7. Clinical symptoms/signs suggestive of other diseases e.g. sepsis.
Commonly, neonatal jaundice occurs for two reasons:
1. Infants have too many red blood cells. It is a natural process for the baby's body to break down these excess red blood cells, forming a large amount of bilirubin. It is this bilirubin that causes the skin to take on a yellowish color.
2. A newborn's liver is immature and cannot process bilirubin as quickly as he will be able to when he gets older. This slow processing of bilirubin has nothing to do with liver disease. It merely means that the baby's liver is not as fully developed as it will be, and thus, there is some delay in eliminating the bilirubin.
Let us hope my baby will be okay by tomorrow..
Jaundice is apparent clinically when the level of bilirubin in the serum rises above
85μmol/l (5mg/dl). Physiological jaundice is a reflection of the bilirubin load to the liver, rate of hepatic excretion (liver maturity) and ability of the serum binding rotein to retain the bilirubin within the plasma.
And from the lab test at the clinic, my baby got 215μmol/l and considered as a serious Jaundice. Another blood test to be conduct tomorrow, if the reading increases, then my baby will need to have a hospital management. I pray to god that he will be okay by tomorrow.
What can go wrong in jaundice?
Elevated serum bilirubin can result in kernicterus, when unconjugated bilirubin is deposited in the cell wall of neurons in basal ganglia, brain stem and cerebellum resulting in cell death. Kernicterus is associated with a high mortality, and survivors usually suffer sequelae like athetoid cerebral palsy, high frequency hearing loss,paralysis of upward gaze and dental dysplasia. The factors influencing bilirubin toxicity in the brain cells of the neonate are complex and incompletely understood. There is no specific level of total serum bilirubin above which kernicterus can be predicted to happen.
When should a neonate be referred for hospital management? (When to worry?)
The following are indications for referral.
1. Jaundice below umbilicus, corresponding to serum bilirubin of 12-15 mg/dl (200-250 μmol/L).
2. Jaundice up to level of the sole of the feet - likely to need exchange transfusion.
3. Jaundice within 24 hours of life.
4. Rapid rise of serum bilirubin of more than 8.5 μmol/L/hour (>0.5 mg/dl/hour).
5. Prolonged jaundice of more than 14 days - other causes/conditions need to be excluded e.g. neonatal hepatitis, biliary atresia.
6. Family history of significant haemolytic disease or kernicterus
7. Clinical symptoms/signs suggestive of other diseases e.g. sepsis.
Commonly, neonatal jaundice occurs for two reasons:
1. Infants have too many red blood cells. It is a natural process for the baby's body to break down these excess red blood cells, forming a large amount of bilirubin. It is this bilirubin that causes the skin to take on a yellowish color.
2. A newborn's liver is immature and cannot process bilirubin as quickly as he will be able to when he gets older. This slow processing of bilirubin has nothing to do with liver disease. It merely means that the baby's liver is not as fully developed as it will be, and thus, there is some delay in eliminating the bilirubin.
Let us hope my baby will be okay by tomorrow..
