Jaundice or also known as icterus is a yellowish discoloration of hands, sclera and other mucus membranes due to increase production of bilirubin in the blood. Bilirubin is the one responsible for the pigmentation of the skin and sclera. It is a waste product of the iron that circulates in our blood stream after being removed from haemoglobin. The excess of this waste product causes yellowish pigmentation over the skin, sclera, and mucus membranes and even in the body fluids. This substance is also responsible for the pigmentation of feces that makes it to become brown in color.
Types of Jaundice
The word jaundice is derived from the middle French word jaunisse where jaun means “yellow” and isse “ness”, thus the yellowness comes from the middle French word jaunisse. Jaundice may be classified into four types:
• Hepatocellular jaundice– this type of jaundice results from the damaged caused directly to the liver by any type of liver diseases.
• Haemolytic jaundice – it is due to accelerating breakdown of erythrocytes from red blood cells that leads to increased production of bilirubin this process is also known as hemolysis.
• Obstructive jaundice – a presence of obstruction over the bile duct, a tube that carries bile from the liver to the gallbladder and small intestine, thus stopping the bilirubin to leave the liver.
• Neonatal jaundice – jaundice may be normally present during the first few days of a newborn and suddenly goes away. For preterm infants it usually lasts for two weeks with a rise of serum bilirubin level of about 225 umol/l or 15 mg/dL and for term infants it last for 10 days with a quick increase of serum bilirubin level of up to 204 umol/l or 12 mg/dL; this value is for phase 1 of physiological jaundice. For phase 2 the bilirubin levels decrease to around 34 umol/l or 2 mg/dL for around two weeks and can last more than a month for both preterm and term infants. If the jaundice last for longer period, it’s better to consult your physician to check for pathological jaundice and other underlying cause.
Jaundice may occur due to many reasons and some of them are the following:
• Blood diseases such as haemolytic anemia.
• Genetically acquired such as Gilbert’s syndrome (a disease in which enzymes are impaired to process the excretion of bile).
• Damage to the liver such as hepatitis or liver cirrhosis.
• Bile ducts obstruction such as cholelithiasis (a condition in which the duct of the bile is obstructed thus interrupting the excretion of bile from the liver)
Manifestations of jaundice
• Yellowish discoloration of sclera, hands and mucus membranes
• Pruritus or itchiness- due to inability of the bilirubin to convert from indirect to direct bilirubin
• Body malaise or fatigue– because of accumulation of ammonia to the brain hence increasing intracranial pressure resulting to brain encephalopathy.
• Abdominal pain- related to bile obstruction
• Weight loss
• Fever- presence of infection
• Gray stool accompanied by colicky pain
• Tea colored urine
A specific diagnosis is required to properly determine the best treatment for having jaundice. The specification will directly treat the underlying cause more than the jaundice itself. Function of the liver has a huge relativity of having jaundice. Having a healthy balanced diet, lifestyle including avoiding or refraining from drinking alcohol is some of the crucial key points to prevent jaundice and its underlying causes.
Jaundice in neonates are usually harmless that can be seen around the 2nd day after birth lasted until 8th day. Causes may be physiological, due to breast feeding and can also be pathological due to some congenital disorders such as blood incompatibility. Blood group incompatibility (Rh or ABO disorders) occurs if the baby’s blood type is different to the mother’s blood type. The antibodies produced may destroy the neonate’s red blood cells that will then cause a sudden rise of bilirubin in the baby’s blood. This compatibility causes the most serious form of jaundice in the neonate; however, it can be prevented by injecting Rh immune globulin to the mother within 72 hours after delivery that will prevent formation of antibodies to the mother that will delimit the danger of incompatibility for the next babies.
In physiologic jaundice, the bilirubin level goes back to its normal functioning and interventions are usually not needed. But in pathologic jaundice, phototherapy is one of the most common treatments for it. Increasing the breast feeding for the bilirubin to pass out easily is also needed as an intervention. Admission to the hospital is commonly done if the baby’s bilirubin is extensively high.
Jaundice in Newborn
Liver immaturity is one of the main reasons why jaundice occurs in newborn. Because of this, the immature liver does not have enough capacity to remove the bilirubin that is present in the blood. Jaundice in newborn may be due to 2 reasons:
• Physiologic jaundice- most ordinary form of jaundice in newborn, this is usually related to the immature liver of the baby that causes the bilirubin to increase in the blood of the blood; however, it is normal and disappears several days after birth.
• Pathologic jaundice- this type of jaundice is due to some serious health condition that needs urgent treatment. These conditions may be the following:
o Hemolysis- destruction of healthy red blood cells of the newborn
o Polycythemia- excessive production of red blood cells
o glucose 6 phosphate dehydrogenase deficiency
o Crigler-Najjar syndrome and Lucey-Driscoll syndrome
Symptoms and diagnosis of jaundice in newborn is normally present during the 2nd and 3rd day after birth starting from the head and progresses downwardly. The attention of the health care provider should be called if the following facts are present in the baby:
• Jaundice is present 24 hrs after birth
• Intense and progressive jaundice
• Fever of 38 degrees celsius taken rectally
• Fatigue is noted.
Diagnosis of jaundice in newborn is the following:
• Coomb’s test- checks the antibodies that is responsible for destroying the red blood cells of the baby
• Complete blood count
• Reticulocyte count is done to make sure if the baby is producing enough red blood cells
Observe your baby and take note of the daily progress so you can be able to relay it to the physician clearly so proper medical intervention may be given immediately.