From the Guidelines
Neonatal jaundice is primarily caused by elevated bilirubin levels in a newborn's blood, with physiological jaundice being the most common cause, occurring when a newborn's liver is not mature enough to efficiently process bilirubin. The causes of neonatal jaundice can be categorized into several key areas, including:
- Physiological jaundice, which typically appears 2-3 days after birth and resolves within 1-2 weeks without treatment 1
- Blood type incompatibilities (ABO or Rh incompatibility) between mother and baby, leading to hemolytic disease of the newborn
- Breast milk jaundice, which may occur in breastfed infants, appearing after the first week and potentially lasting several weeks
- Conditions that increase red blood cell breakdown, such as bruising during delivery, polycythemia, or genetic disorders like G6PD deficiency
- Infections, metabolic disorders, and liver diseases, which may cause pathological jaundice
- Prematurity, which increases the risk of jaundice due to even less developed liver function
- Certain medications that can interfere with bilirubin processing, and intestinal obstruction, which may prevent bilirubin excretion
According to the most recent guidelines, identifying the specific cause of neonatal jaundice is crucial for appropriate management, which may range from increased feeding and phototherapy to exchange transfusion in severe cases 1. Phototherapy is an essential intervention for severe hyperbilirubinemia, especially in neonates at high risk, and its use reduces the risk of bilirubin neurotoxicity as well as the use of exchange transfusions. The timing of intervention is guided by performing serial measurements of total serum/plasma bilirubin concentrations and screening for the presence of intrinsic risk factors for bilirubin neurotoxicity 1.
From the Research
Causes of Neonatal Jaundice
The causes of neonatal jaundice can be understood by examining the balance between the production and elimination of bilirubin. Several factors contribute to this condition, including:
- Increased red blood cell turnover 2, 3
- Immature liver enzymes 2
- Delayed stooling patterns 2
- Hemolysis, which can be due to various conditions such as blood group incompatibility 4
- Genetic deficiencies or polymorphisms that affect bilirubin elimination 4
- Breakdown of red blood cells, leading to an increase in serum bilirubin levels 3
Pathophysiology
Neonatal jaundice occurs when there is an imbalance between the production and elimination of bilirubin, resulting in elevated bilirubin levels. This can be due to various factors, including:
- Increased bilirubin production, such as in cases of hemolysis 4
- Impaired bilirubin elimination, such as in cases of genetic deficiencies or polymorphisms 4
- Delayed liver maturation, leading to reduced bilirubin conjugation and excretion 2
Risk Factors
Several risk factors contribute to the development of neonatal jaundice, including: