What Causes Jaundice in Newborns?
Jaundice in newborns occurs when there is an imbalance between the production and clearance of bilirubin, a yellow pigment formed during the normal breakdown of red blood cells. Common causes include:
- Physiological Jaundice: The most common type of jaundice in newborns, caused by the immaturity of the liver, which is unable to efficiently process and remove bilirubin[3][4].
- Breastfeeding Jaundice: Insufficient breastfeeding in the first few days of life can lead to dehydration or reduced bilirubin excretion, causing jaundice[3][5].
- Breast Milk Jaundice: Certain substances in breast milk can interfere with the liver’s ability to process bilirubin, resulting in prolonged jaundice in some infants[5].
- Hemolysis: Conditions like blood group incompatibility (e.g., Rh or ABO incompatibility) or G6PD deficiency can lead to the rapid breakdown of red blood cells, causing high bilirubin levels[4][6].
- Infections or Other Causes: Infections (e.g., sepsis), genetic, or metabolic disorders may also lead to jaundice in newborns[3][6].
Jaundice in newborns typically peaks between the second and fourth day of life, as bilirubin levels rise during this period due to the immaturity of the liver[3][5]. Before discharge from the hospital, most newborns undergo jaundice screening using a transcutaneous bilirubinometer or a blood test to measure bilirubin levels, ensuring early detection and management[6].
How Is Jaundice Measured?
1. Clinical Observation
Healthcare providers often perform a visual assessment, checking for yellowing in the baby’s skin and sclera (white part of the eyes)[3].
2. Transcutaneous Bilirubinometer (TcB)
3. Total Serum Bilirubin (TSB)
4. Mobile Application for At-Home Monitoring
In Singapore, a new mobile application enables parents to monitor jaundice levels in newborns from home. This non-invasive technology uses a smartphone camera and a color-calibration sticker to analyse the baby’s skin and estimate bilirubin levels. Studies have shown that its accuracy is comparable to traditional diagnostic tools, making it a convenient option for early detection and reducing the need for frequent clinic visits[7].
Comparing Measurement Methods
| Method | Invasiveness | Accuracy | Convenience | Recommended Usage |
|---|---|---|---|---|
|
Clinical Observation |
Non-invasive |
Low |
High |
Initial Screening |
|
Transcutaneous Bilirubin |
Non-invasive |
Moderate |
High |
Routine Monitoring |
|
Total Serum Bilirubin |
Invasive |
High |
Moderate |
Confirmatory Diagnosis |
|
Mobile Application |
Non-invasive |
High |
Very High |
At-home Monitoring |
Threshold and Tolerance Levels for Jaundice
The thresholds for intervention depend on the baby’s age in hours and risk factors. The following table provides guidance based on clinical guidelines from KK Women’s and Children’s Hospital (KKH)[3], the Health Promotion Board (HPB)[4], and recommendations from the American Academy of Pediatrics (AAP)[5]:
| Age (in hours) | Low-Risk Infants | Medium-Risk Infants | High-Risk Infants | |||
|---|---|---|---|---|---|---|
|
|
(mg/dL) |
(mmol/L) |
(mg/dL) |
(mmol/L) |
(mg/dL) |
(mmol/L) |
|
< 24 |
6.0 |
102.6 |
5.0 |
85.5 |
4.0 |
68.4 |
|
24-48 |
9.0 |
153.9 |
8.0 |
136.8 |
7.0 |
119.7 |
|
48-72 |
12.0 |
205.2 |
11.0 |
188.1 |
10.0 |
171.0 |
|
> 72 |
15.0 |
256.5 |
14.0 |
239.4 |
13.0 |
222.3 |
Notes:
- Low-risk infants are full-term, healthy newborns without risk factors.
- Medium-risk infants include those with mild prematurity or moderate risk factors.
- High-risk infants include preterm babies or those with significant medical conditions.
When Should Parents Worry About Jaundice?
Parents should seek medical advice if:
- Yellowing spreads to the baby’s abdomen, arms, or legs[3].
- The baby appears lethargic, feeds poorly, or is difficult to wake[5].
- Jaundice persists beyond two weeks of age[4].
- Bilirubin levels exceed the thresholds outlined above[5].
These recommendations align with healthcare guidelines from KK Women’s and Children’s Hospital (KKH)[3], the Health Promotion Board (HPB)[4], and the American Academy of Pediatrics (AAP)[5], ensuring timely and appropriate intervention.
Management of Jaundice
If bilirubin levels exceed the recommended thresholds, immediate action is required:
- Consult a Doctor: Seek medical advice to confirm bilirubin levels and assess the baby’s condition.
- Phototherapy: The most common treatment, where the baby is placed under special blue light to break down bilirubin[3].
- Exchange Transfusion: In severe cases, blood transfusions may be required to quickly lower bilirubin levels[5].
- Continue Monitoring: Regular follow-ups and bilirubin checks ensure the condition is under control[4].
Where Can Parents Seek Help in Singapore?
In Singapore, parents can consult:
- Polyclinics: For initial screening and referrals.
- Hospitals: Such as KK Women’s and Children’s Hospital (KKH), National University Hospital Singapore (NUHS), Singapore General Hospital (SGH), and other private hospitals for advanced care and treatments.
- Pediatricians: For personalized management and follow-up care.
Final Thoughts
Jaundice in newborns is a common and manageable condition when detected early. With advancements in diagnostic methods and clinical care, parents have access to effective monitoring and treatment options. However, vigilance remains crucial. Parents should promptly consult healthcare professionals if jaundice levels exceed safe ranges, ensuring timely and effective intervention to safeguard their newborn’s well-being.
References
- American Academy of Pediatrics. “Clinical Practice Guideline Revision: Management of Hyperbilirubinemia in the Newborn Infant 35 or More Weeks of Gestation.” Pediatrics, 2022. Available online.
- American Academy of Pediatrics. “Management of Hyperbilirubinemia in the Newborn Infant 35 or More Weeks of Gestation.” Pediatrics, 2004. Available online.
- SingHealth. “Neonatal Jaundice.” Available online.
- National University Health System (NUHS). “Jaundice in Newborns.” Available online.
- Academy of Medicine, Singapore. “Guidelines on Evaluation and Management of Neonatal Jaundice.” Available online.
- Singapore General Hospital (SGH). “Neonatal Jaundice: Parent Guide 2024.” Available online.
- Channel NewsAsia. “Newborn infant jaundice: How to check with app developed by SGH, SingHealth Polyclinics.” Available online.
