What is the cause of jaundice in a 1-month-old infant?

From the Guidelines

Jaundice in a 1-month-old infant requires immediate medical attention to rule out pathological causes and prevent potential long-term complications, such as kernicterus, which can cause permanent brain damage. The infant should be seen by a healthcare provider promptly for assessment of bilirubin levels through blood testing, as recommended by the American Academy of Pediatrics 1. If bilirubin levels are elevated, phototherapy is the recommended treatment, which involves exposing the infant to special blue lights that help break down bilirubin in the skin 1. During phototherapy, the baby should be undressed except for a diaper to maximize skin exposure, with eyes covered for protection. Feeding should continue normally, with increased frequency to promote bilirubin excretion through stool.

Key Considerations

• Potential causes of jaundice at this age include breastfeeding jaundice, breast milk jaundice, blood type incompatibilities, liver dysfunction, biliary atresia, or underlying infections.
• Parents should watch for signs of severe jaundice, including:
  • Extreme yellowing extending to the abdomen
  • Lethargy
  • Poor feeding
  • High-pitched crying
  • Arched back which require emergency care.

Phototherapy Guidelines

• Total serum bilirubin (TSB) should be used as the definitive diagnostic test to guide all interventions 1.
• Intensive phototherapy is recommended at thresholds based on gestational age, neurotoxicity risk factors, and age of the infant in hours.
• The decision to discontinue phototherapy should be individualized, considering the TSB level at which phototherapy was initiated, the cause of the hyperbilirubinemia, and the risk of rebound hyperbilirubinemia 1.

Follow-up Care

• Infants who received phototherapy should have a follow-up TSB measure within 1 to 2 days after phototherapy discontinuation, unless it has been ≥24 hours since phototherapy was stopped, in which case it is an option to use transcutaneous bilirubin (TcB) 1.
• Care should be escalated when an infant’s TSB level is at or above the exchange transfusion threshold or within 0 to 2 mg/dL below the exchange transfusion threshold, with intravenous hydration and emergent intensive phototherapy as soon as possible 1.

From the Research

Jaundice in 1-Month-Old Infants

• Jaundice is a common condition in infants, caused by an increase in serum bilirubin levels, largely as a result of breakdown of red blood cells 2.
• About 50% of term and 80% of preterm babies develop jaundice, which usually appears 2 to 4 days after birth, and resolves spontaneously after 1 to 2 weeks 3.
• In 1-month-old, healthy, term infants, total bilirubin was > 5 mg/dl in 20.2% of the infants and > 10 mg/dl in 6% of the group 4.

Diagnosis and Management

• Phototherapy is a simple and effective way to reduce the bilirubin level, and most term babies have 'physiological' jaundice which responds to a short period of phototherapy, and requires no other treatment 2.
• The combination of phenobarbital and phototherapy may enhance the decline of total serum bilirubin and decrease the need for blood exchange transfusion in newborns with isoimmune hemolytic disease 5.
• High levels of conjugated bilirubin in a term baby can indicate biliary atresia, and babies with persisting jaundice must have their level of conjugated bilirubin measured 2.

Treatment Thresholds

• The cut-off level for investigating prolonged jaundice in term, 1-month-old, healthy infants in the Turkish population should be > 5 mg/dl 4.
• Current management of jaundice in the UK is guided by the NICE guideline, and any infant with high serum bilirubin or a rapidly rising bilirubin level needs to be treated urgently to avoid neurotoxicity 2.