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Home » Medical » Diseases » Child Health » Jaundice

Jaundice

Jaundice is the most common of all liver disorders. Jaundice is a yellow color of the skin, the mucous membranes, or the eyes. Jaundice comes from the French word "Jaune" which means yellow. It is also known as icterus. Jaundice typically appears in a 'top to bottom' progression (starting with the face, progressing toward the feet), and resolves in a 'bottom to top' manner.

It is caused by high levels in blood of the chemical bilirubin, a byproduct of old red blood cells. The color of the skin and sclerae vary depending on the level of bilirubin. When the bilirubin level is mildly elevated, they are yellowish. When the bilirubin level is high, they tend to be brown. It is usually processed by the liver and excreted in the baby's stool.

Neonatal Jaundice
A common condition in newborns, when a baby has jaundice, either too much bilirubin is being produced or the liver does not get rid of it quickly enough. A newborn baby's liver is not fully matured, so jaundice is common during a baby's first few days of life.

There are following kinds of jaundice:

  1. Physiological jaundice: It is common in newborn babies. It usually becomes noticeable during the baby's first three to five days of life. It disappears as the baby's liver matures. This type of jaundice is not harmful.
  2. Pathological jaundice: In some situations, however, there is so much bilirubin in a baby's blood that it can be harmful. This condition is called pathological jaundice. If the level of bilirubin becomes very high, it may affect some of the baby's brain cells. This may cause a baby to be less active. In rare cases, a baby may have seizures (convulsions). Pathological jaundice may also lead to deafness, cerebral palsy and/or mental retardation. Pathologic jaundice can occur in children or adults. It arises for many reasons, including blood incompatibilities, blood diseases, genetic syndromes, hepatitis, cirrhosis, bile duct blockage, other liver diseases, infections, or medications.
  3. Jaundice of pre-maturity: this occurs frequently in premature babies since they take longer to adjust to excreting bilirubin effectively.
  4. Breast milk jaundice: In 1% to 2% of breastfed babies, jaundice can be caused by substances produced in their mother's breast milk that can cause the bilirubin level to rise above 20 mg. These substances can prevent the excretion of bilirubin through the intestines. It starts at 4 to 7 days and normally lasts from 3 to 10 weeks. The cause is thought to be inadequate milk intake, leading to dehydration or low caloric intake. It is a type of physiologic or exaggerated physiologic jaundice.
  5. Not-enough-breast milk Jaundice: This may occur because the baby is not getting enough milk. This is because sometimes the mother's milk takes a longer than average time to "come in", or because the baby is poorly latched on and thus not getting the milk which is available.6. Blood group incompatibility (Rh or ABO problems): if a baby has a different blood type than the mother, the mother might produce antibodies that destroy the infant's red blood cells. This creates a sudden buildup of bilirubin in the baby's blood. Incompatibility jaundice usually begins during the first day of life.
  6. Inadequate liver function: Jaundice may be related to inadequate liver function due to infection or other factors.

 

Causes of Jaundice
Jaundice is caused by the accumulation of bilirubin in the blood. Bilirubin is formed when red blood cells are broken down. Jaundice is common since bilirubin production normally two to three times higher in newborns, as compared to adult levels.

  • Obstruction of the bile ducts: Jaundice may be caused by an obstruction of the bile ducts which normally discharge bile salts and pigment into the intestine. The bile gets mixed with blood and this gives a yellow pigmentation to the skin.
  • Acute hepatitis: liver inflammation due to a variety of causes including hepatitis A, B, C, D, and E viral infections, alcohol abuse, and some medications and toxins.
  • Hemolytic anemia: Any conditions that lead to a significant increase in the destruction of red blood cells and to an increase in the production of bilirubin can cause jaundice.
  • Gilbert's syndrome: It is a mild inherited condition which is associated with decreased bilirubin conjugation due to a decrease in enzyme activity. The affected patient may have temporary jaundice.
  • Cirrhosis: It can cause jaundice in its late stages

Other Causes include:

  • Newborn jaundice (physiologic jaundice) 
  • Breastfeeding jaundice 
  • Breast milk jaundice 
  • Viral hepatitis (hepatitis A, hepatitis B, hepatitis C, hepatitis D, and hepatitis E) 
  • Hemolytic anemia 
  • Disorders present since birth that cause problems processing bilirubin (Gilbert's syndrome, Dubin-Johnson syndrome, Rotor's syndrome, or Crigler-Najjar syndromes) 
  • Biliary atresia 
  • Autoimmune hepatitis 
  • Malaria

There are certain risk factors of Jaundice which can cause problems for babies: 

  • who are born before 37 weeks' gestation; 
  • whose weight is less than 2500 g at birth; 
  • whose blood group is incompatible with their mothers' blood group; 
  • who have jaundice early in their life; 
  • who have an infection; and 
  • who needed resuscitation at birth

 

Signs & Symptoms of Jaundice
The symptoms of jaundice are extreme weakness, headache, and fever, loss of appetite, severe constipation, nausea, and yellow discoloration of the eyes, tongue, skin, and urine.

The patient may also feel a dull pain in the liver region. Obstructive jaundice may be associated with intense itching.

Call your doctor if your baby shows any of the following symptoms:

  • Refuses breastfeeding or bottle feeding, or is sleepy all the time; 
  • Has lost a significant amount of weight 
  • If the baby is extremely jaundiced then baby's arms and legs are yellow. 
  • Baby sleeps for a longer time than usual.
  • The urine color is dark, while the stool appears normal.
  • High levels of bilirubin can cause high-pitched crying, Apnea (temporary stoppage of breathing), listlessness, Seizures and arched backs in the infants.
  • Extremely high levels of bilirubin (Hyperbilirubinemia) lead to Kernicterus, a condition where the brain is severely damaged.

 

Myths about Jaundice

Myth: Breast milk should be stopped because the mother's milk is defective
A general impression that mother's milk is not suiting the child will do more harm than good since it shall disturb the vital breast milk supply to the newborn. Breast Milk Jaundice is a well defined medical entity and can be diagnosed only by the Pediatrician.

Myth: Keeping the child in sunlight can cure jaundice
It is true that Sunlight does help as a source of warmth, for vitamin D production but has no role in reducing Jaundice.

Myth: Keeping the child under a tube light at home is helpful
Phototherapy is specially designed set of tube lights of a specific radiation wavelength kept at a specified distance from the newborn and it is a specialized technique and a short cut of putting the child under a tube light at home is simply deceive oneself. If the baby need for Phototherapy then it has to be done under guidance of a specialized doctor in a Hospital.   

Myth: Mothers should avoid foods that contains fat
Again there is no scientific reason, because fats have no relation with fats

Myth: Mothers should not eat / drink / wear yellow things
There is No scientific reason which indicate that the mothers should not drink/eat/wear yellow things.

Diagnosis of Jaundice
Newborn jaundice can be diagnosed by visual examination, transcutaneous (through the skin) measurement, and blood testing.

Physical examination - The initial diagnosis of neonatal jaundice is based on a physical examination, which is done by placing the infant by a window and checking for signs in natural sunlight. At this stage the baby must be in the care of a health professional.

Visual examination - Visual examination is often used by healthcare providers to identify a newborn with jaundice. Visual examination is performed by quickly pressing and releasing the skin. This causes the skin to become pale (called blanching), allowing a clinician to see if the skin is yellowed as blood returns to the area.

The diagnosis is made by recognition of the patient's appearance and accompanying symptoms.

  • A blood test will confirm the raised bilirubin level and other tests such as those for hepatitis and haemolysis are also done on the blood. 
  • Ultrasound is a good way to inspect the liver and bile ducts for signs of obstruction, and often can give useful information on the pancreas gland. 
  • CT scanning also helps diagnose obstructive jaundice accurately

 

The following diagnostic tests may be performed: 

  • Blood serum bilirubin 
  • Complete blood count 
  • Liver biopsy 
  • Liver function tests and cholesterol 
  • Prothrombin time 
  • Ultrasound of the abdomen 
  • Urine and fecal urobilinogen

 

Preventions of Jaundice
Although jaundice cannot be totally prevented but early recognition and treatment are important in preventing bilirubin levels from rising to dangerous levels. If your baby's color is turning more yellow, promptly call your baby's physician.

  • Feed babies frequently and don't let them become dehydrated.
  • With jaundice, the important thing to prevent is kernicterus -- toxic levels of bilirubin accumulating in the brain. Early identification and treatment of jaundice will usually prevent kernicterus, whatever the cause.

Treatments of Jaundice

Treatment for Neonatal Jaundice
Most jaundice needs no treatment, but when it does, the given below treatments are possible:

  1. Phototherapy (light therapy) is considered very safe and effective. Placing your baby under blue "bililights" lights - naked in a bassinet, with his eyes covered - will often do the trick because ultraviolet light changes the bilirubin to a form that your baby can more easily dispose of in his urine. 
  2. Fiber Optic Blanket: Another option involves wrapping your baby in a fiber-optic blanket called a bili-blanket or bili-pad. With a prescription from your doctor, you may be able to rent one of these blankets to treat your baby at home.

Phototherapy is usually effective, but if a baby develops a severe case of jaundice, or his bilirubin levels continue to rise despite phototherapy treatment, he may need to be admitted to the intensive care unit for a blood transfusion called an "exchange transfusion."

Something else you can do on your own to help reduce jaundice is make sure that your baby is getting plenty of breast milk or formula - so he'll have frequent bowel movements. If you have any concerns about jaundice, check with his doctor to make sure you're taking the right steps to get your baby back in the pink.

If left untreated, Hyperbilirubinemia due to Neonatal Jaundice can result in mental retardation, Cerebral palsy, behavioral problems, hearing loss or even loss of life.


Home treatment for Jaundice
Home treatment for Jaundice includes:

  • Treatment using Radish Leaves
    The leaves of radish should be pounded and their juice extracted through cloth. Half a liters of this juice should be taken daily by an adult patient In most cases, complete cure can be ensured within eight or ten days.
  • Treatment using Tomato
    A glass of fresh tomato juice, mixed with a pinch of salt and pepper, taken early in the morning, is considered an effective remedy for this disease.
  • Treatment using Snake Gourd Leaves
    An infusion of the leaves should be prepared by mixing 15 gm of dry leaves in 250 ml of boiling water. Next, a decoction of coriander seeds in 500 ml of water till it is reduced by one-third. The infusion should be given in doses of 30 to 60 ml, mixed with the decoction of coriander seeds, thrice daily.
  • Treatment using Almonds, Dried Dates and Cardamoms
    Eight kernels of almonds, two dried dates, and five small cardamoms should be soaked overnight in water. The outer coating of the almond kernels and the inner seeds of dried dates should be removed the next morning and the whole material should be rubbed into a fine paste. Then, fifty grams of sugar and an equal amount of butter should be mixed in it and the patient should lick this mixture.
  • Treatment using Sugarcane Juice
    One glass of sugarcane juice, mixed with the juice of half a lime, and taken twice daily, can hasten recovery from jaundice.
  • Treatment using Lemon
    The patient should be given 20 ml of lemon juice mixed with water several times a day. This will protect the damaged liver cells.
  • Treatment using Barley Water
    One cup of barley should be boiled in three liters of water and simmered for three hours and should be given to the patient several times during the day.
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