Types of Jaundice in Infants

1. Physiologic
2. Pathological

A. Physiologic Jaundice
It is multi-factorial, due to increased bilirubin production, red blood cell volume, short survival of the red blood cells, ineffective uptake of bilirubin from blood , immature functioning of liver in excretion of the bile.
This often appear 2-3 days after birth but resolves in the first 2 weeks of life. (1)

B. Pathological
The group of infants more prone to pathological jaundice includes:
a. Preterm/ low birth weight infants
b. G6PD Deficiency
c. Baby and mother ABO/ Rhesus incompatibility
d. Inadequate Breastfeeding
e. Infants of Diabetic mothers
f. Infants with polycythaemia and cephalohematoma

C. Breastfeeding Jaundice
Occurs very early in the newborn's life due to poor milk intake, resulting in an exaggerated physiological response.

D. Breastmilk Jaundice
It is a common type of newborn jaundice that may occur from 14 to 21 days. It is thought to be due to metabolites in breast milk that reduce the efficiency in the hepatic clearance of the bilirubin, and also increases the re-absorption of bilirubin from the hepato-intestinal tract.

1: Guidelines on Evaluation and Management of Neonatal Jaundice
by Academy of Medicine Singapore, College of Paediatrics and Child Health, Singapore, October 2018

2. When Babies Turn Yellow, Singapore Med J 2015; 56(11): 599-603, by Mark Chung Wai Ng, MMed, FCFP, Choon How How2, MMed, FCFP

When is Jaundice more dangerous?

Jaundice can cause problems for some babies, including:

  • Preterm babies born before 37 weeks’ gestation;

  • Babies who weigh less than 2500 g at birth;

  • Babies whose blood group is incompatible with their mothers’ blood group;

  • Babies who develop jaundice early in life, especially during the first 24 h;

  • Babies whose jaundice has moved into the arms and legs;

  • Babies who have an infection;

  • Babies who have bruises and a difficult delivery (for example, where forceps have to be used); and

  • Babies whose siblings had jaundice at birth and needed treatment.

 

After I leave the hospital, when should I call my doctor?

Call us immediately if your baby shows any of the following symptoms:

  • Refuses breastfeeding or bottle feeding;

  • Is sleepy all the time;

  • Has lost a significant amount of weight (more than 10% of her weight at birth); or

  • Is extremely jaundiced (arms and legs are a yellow or orange colour, whites of baby's eyes look yellow)

Should i bring my baby for a Jaundice checkup?

We strongly believe that baby jaundice should be accessed by all if given the chance due to high occurrence rate. (60% in infants)

Identifying Jaundice early helps to manage the bilirubin levels, and on top of relying on eyesight, we suggest a proper neonatal assessment by professionals.

TcB Scans are used rather than the invasive SB(heel prick test). 

Transcutaneous Bilirubin(TCB) measurement is used by DrJaundice to check for jaundice. 

TCB is currently widely used in the Singapore polyclinics and paediatrics clinic replacing serum bilirubin(SB) as a pain-free way of measuring and monitoring of neonatal jaundice. There are still many clinics using the more painful blood test (SB) for measurement.

"When Madam Nursurya Zaini took her infant son to be screened for jaundice two years ago, she saw laboratory technicians draw blood from his heel. The baby bawled, which pained the mother as well"

 

Reference from: Straits Times AUG 8, 2018

https://www.straitstimes.com/singapore/new-painless-jaundice-test-for-newborns-at-polyclinics

 


 

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