Neonatal jaundice is a condition where babies have yellow skin or eyes because of excess bilirubin levels. It occurs when newborns’ blood contains too much bilirubin, an orange pigment produced by red blood cells.
What is Jaundice?
“Jaundice” is the medical term that describes the yellowing of the skin and eyes. Jaundice itself is not a disease, but it is a symptom of several possible underlying illnesses. There is too much bilirubin in your blood. Bilirubin is a yellow pigment that is created by the breakdown of dead red blood cells in the liver. Normally, the liver gets rid of bilirubin, along with old red blood cells.
Jaundice may show a serious problem with the function of your red blood cells, liver, gallbladder, or pancreas.
Infant Jaundice or Neonatal Jaundice
Infant jaundice is a common condition, particularly in babies born before 38 weeks’ gestation (preterm babies) and some breastfed babies. Infant jaundice usually occurs because a baby’s liver isn’t mature enough to get rid of bilirubin in the bloodstream. In some babies, an underlying disease may cause infant jaundice.
Jaundice occurs when there is too much of bilirubin in the blood. Bilirubin is created when in the body when old red blood cells carrying oxygen to all parts of our body breakdown. This breakdown of the red blood cells is a normal process. The red blood cells have a lifespan of 120 days and new red blood cells are manufactured to replace the dying ones.
The bilirubin which gets created when the old red blood cells break down, circulate through the bloodstream and travels to the liver. From the liver, it is excreted into the bile duct and stored in the gallbladder. From the gallbladder, the bilirubin is released in small quantities, as bile, into the small intestine. Here, it helps to digest fats and then is eventually excreted from the body with a stool.
When the liver is not metabolizing bilirubin the way it is supposed to, jaundice occurs.
Pre-Hepatic (liver) Causes Of Jaundice
Jaundice caused during the pre-hepatic phase is because of the excessive destruction (hemolysis) of red blood cells from various conditions. This rapid increase in bilirubin levels in the bloodstream overwhelms the liver’s capability to properly metabolize the bilirubin, and the levels of unconjugated bilirubin increase. Conditions which can lead to an increase in the hemolysis of red blood cells include:
- Sickle cell disease
- Hereditary spherocytosis
- Glucose-6-phosphate dehydrogenase deficiency (G6PD)
- Drugs or other toxins
- Autoimmune disorders
Hepatic (liver) Causes of Jaundice
Jaundice caused during the hepatic phase can arise from abnormalities in the metabolism and/or excretion of bilirubin. This can lead to an increase in both unconjugated and/or conjugated bilirubin levels. Conditions with a hepatic cause of jaundice include:
- Acute or chronic hepatitis(commonly viral [Hepatitis A, B, C, D, E] or alcohol related)
- Cirrhosis (caused by various conditions)
- Drugs or other toxins
- Crigler-Najjar syndrome
- Autoimmune disorders
- Gilbert’s syndrome
- Liver cancer
Post-Hepatic (liver) Causes of Jaundice
Jaundice from a post-hepatic cause arises from a disruption (an obstruction) in the normal drainage and excretion of conjugated bilirubin as bile from the liver into the intestine. This leads to increased levels of conjugated bilirubin in the bloodstream. Conditions that can cause post-hepatic jaundice include:
- Cancer (pancreatic cancer, gallbladder cancer, and bile duct cancer)
- Strictures of the bile ducts
- Parasites (for example, liver flukes)
Symptoms of Jaundice in Adults
As already mentioned, jaundice is not a disease, but a visible sign of an underlying disease process. Individuals with jaundice will have yellow discolouration of the skin to varying degrees, and may also exhibit yellowing of the mucous membranes and of the white of the eyes. However, depending on the underlying cause of jaundice, individuals may experience different symptoms. Some individuals may have very few symptoms at all, while others may experience more severe and pronounced symptoms. Individuals with jaundice may experience any of the following signs and symptoms:
- pale-coloured stools,
- dark-coloured urine,
- skin itching
- nausea and vomiting
- rectal bleeding
- fever and chills
- weight loss
- loss of appetite
- abdominal pain
- a headache
- swelling of the legs
- swelling and distension of the abdomen because of the accumulation of fluid (ascites)
Risk Factors for Jaundice in Adults
The risk factors for developing jaundice vary based on the underlying cause.
- Certain individuals with hereditary conditions (for example, thalassemia or hereditary spherocytosis) are at an increased risk of developing jaundice from hemolysis.
- Individuals who consume alcohol heavily are at an increased risk of developing alcoholic hepatitis, pancreatitis, and cirrhosis, leading to jaundice.
- People who are at an increased risk of exposure to the different viral hepatitis (for example, hepatitis B and hepatitis C) are also at risk of developing jaundice at the time of infection or subsequently if the liver disease occurs or if liver cancer develops later.
Diagnosis and Test for Jaundice in Adults
The presence of jaundice requires a comprehensive medical evaluation to determine the cause. Initially, your doctor will take a detailed history of your illness and perform a physical exam, which can sometimes determine the cause of jaundice. Initial blood testing will also be prescribed,
- liver function tests
- complete blood count (CBC)
- electrolyte panel
- lipase levels
- Hepatitis tests
- urinalysis or urine routine
Depending on the results of initial blood tests, further studies may be needed to help diagnose the underlying disease process. In certain cases, imaging studies will need to be got in order to evaluate for any abnormalities of the liver, gallbladder and pancreas. These imaging studies may include abdominal ultrasound, computerized tomography (CT) scan, magnetic resonance imaging(MRI), and cholescintigraphy (HIDA scan).
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