Jaundice

Overview

Jaundice is a disease associated with a yellowish tinge to the skin and whites of the eye. In infants, jaundice occurs because the blood of the baby contains excessive bilirubin – a yellow pigment of the red blood cells.

Jaundice is caused by several factors among them being gallstones, hepatitis, and tumors. Infant jaundice often occurs because a baby’s liver is not fully developed to eliminate bilirubin bile pigment in the bloodstream.  In adults, jaundice does not necessarily need to be treated, but in infants, it must be treated immediately.

A study conducted to determine the prevalence of neonatal jaundice in low and middle-income countries in 2016 revealed that more than half of the newborns develop neonatal jaundice (NNJ). In Kenya, the study was conducted at a pediatric referral hospital where a total of 306 infants were admitted with 106 (34.4%) of them being diagnosed with jaundice while 24 of the jaundiced infants died.

A separate study in a Kenyan district hospital conducted from 1990 to 2008 (19yrs) revealed that out of 8,756 neonatal admissions, 811 (9.2%) had severe NNJ and 116 of them died which represented a case fatality rate (CFR) of 14.3%.

Symptoms

The most common symptoms of jaundice include:

  • Yellowish skin and the whites of the eyes
  • Pale Stools
  • Itchiness
  • Dark urine

Accompanying symptoms due to low bilirubin levels include:

  • Abdominal pain
  • Fatigue
  • Weight loss
  • Fever
  • Vomiting
  • Dark urine
  • Pale Stools

Causes

The main cause of jaundice is excess bilirubin (hyperbilirubinemia). It is responsible for the yellow color in the skin, eyes, and mucous membranes.

Newborns generate high levels of bilirubin than adults due to faster breakdown of red blood cells during their first few days of life.

The liver is responsible for filtering bilirubin from the bloodstream, but the infant’s liver is still immature and often unable to remove it as faster as required hence the condition.

Other causes of jaundice include:

The underlying disorder may cause jaundice, especially in infants. These conditions or diseases include;

  • Internal bleeding (hemorrhage)
  • Hepatitis
  • Liver malfunction (gallstone)
  • A deficiency of the enzyme
  • Incompatibility between the baby’s blood and the mother’s blood
  • Infection in the baby’s blood (sepsis)
  • Tumors

Risk Factors

The risk factors associated with jaundice include:

  • Premature birth: Infants born before 38 weeks of gestation are at high risk of developing jaundice
  • Significant bruising during delivery
  • Blood type: Incompatible blood types between the mother and the baby
  • Breastfeeding: Babies who have difficulty nursing or getting enough nutrition from breastfeeding are at higher risk
  • Hemolytic anemia
  • Gilbert’s syndrome
  • Cholestasis
  • Obstruction of the bile duct
  • Inflammation of the bile duct

Diagnosis

The doctor will likely use the history of the patient and physical exam to diagnose jaundice as well as confirm the levels of bilirubin. After that, the doctor will carry out several tests to confirm jaundice:

  • Liver function test: Determines whether or not the liver is functioning properly
  • Bilirubin tests: Determines the levels of bilirubin in the body
  • Hepatitis A, B, and C tests: To determine a range of liver infections
  • Full blood count (FBC) or complete blood count (CBC): Measure levels of red blood cells, platelets, and white blood cells.
  • Further tests may include imaging tests such as MRI, ultrasound scans, and CT scan
  • Endoscopic retrograde cholangiopancreatography (ERCP): Combines endoscopy and X-ray imaging
  • Liver biopsy: To check inflammation, cancer, cirrhosis, and fatty liver.

Treatment

Treatment of jaundice will depend on the underlying cause

The treatment process targets the cause of the disease as opposed to the symptoms

Treatment options available include:

  • Anemia-induced jaundice may be treated through boosting the iron in the bloodstream by either eating more iron-rich foods or taking iron supplements. The doctor will give recommendations on the best approach and give examples of either iron supplements or foods to take.
  • Hepatitis-induced jaundice needs antiviral or steroid medications
  • Obstruction-induced jaundice may require surgery to remove the obstruction
  • If it is caused by the use of medication, treatment may involve altering approaches to an alternative medication.

Treatment of infant jaundice may require admission to the hospital to lower the levels of bilirubin in the bloodstream. Some treatment options for severe infant jaundice include:

  • Phototherapy (Light therapy): Treatment by light rays using a special light to manipulate the structure of bilirubin molecules to excrete them. 
  • Exchange blood transfusion: Repeated withdrawing of baby’s blood and replacing it with donor blood. This procedure is only used if phototherapy fails to work.
  • Intravenous immunoglobulin (IVIg): This occurs if there is ABO or rhesus incompatibility. Infants may have immunoglobulin transfusion, which is a protein in the blood to lower levels of antibodies from the mother that are attacking the red blood cells of the infant.

Complications

If jaundice is not treated, it may lead to the following complications:

Acute bilirubin encephalopathy: Buildup of bilirubin in the brain which is toxic to brain cells. Symptoms include high-pitched crying, fever, poor feeding, sluggishness, and arching of the neck or body. Immediate treatment is required to prevent further damage.

Kernicterus (Nuclear jaundice): A potentially fatal syndrome that takes place if acute bilirubin encephalopathy causes permanent brain damage. Kernicterus may lead to:

  • Permanent upward gaze
  • Hearing loss
  • Improper development of tooth enamel
  • Athetoid cerebral palsy

Prevention

  • Adequate feeding of the infant: 12 breastfeedings in a day for the first several days of life
  • Formula-fed infants to have 1 to 2 ounces of formula every two to three hours for the first week
  • Adults should prevent jaundice by maintaining the health of this vital organ by:
  • Exercising regularly
  • Eating a balanced diet
  • Limited or no alcohol consumption

Sources

https://www.karger.com/Article/FullText/445708

https://www.mayoclinic.org/diseases-conditions/infant-jaundice/symptoms-causes/syc-20373865

https://www.medicalnewstoday.com/articles/165749.php

https://my.clevelandclinic.org/health/diseases/15367-adult-jaundice