Health Tips

What causes newborn’s skin to turn yellow after birth?

The yellowing of skin (and white of eyes) in newborn is known as neonatal jaundice. It occurs commonly in the first week of life due to the accumulation of bilirubin in the skin and mucous membranes. Approximately 65% of newborns will develop the condition which is caused by raised bilirubin (higher than 6 mg/dL) in the blood circulation.

Bilirubin is formed from the breaking down of the red blood cells. It is an important antioxidant that protects newborns from oxygen toxicity in the first days of life due to their general deficient in antioxidants such as catalase, superoxide dismutase and vitamin E.

It is normally processed in the liver before being passed out to the gut as part of bile juice. It is then metabolized by the micro-organism living in the gut before being excreted in stools. Slower rate of excretion in newborns is caused by the absence of gut flora as well as the slow bowel movement which in turn promote bilirubin reabsorption in the gastrointestinal tract. Accumulation of high levels of bilirubin in the body can lead to jaundice.

What are the risk factors for neonatal jaundice?

• Preterm birth: Preterm infants are at higher risk because they may not be able to process bilirubin at the levels of full term babies.
• Blood type.If the mother’s blood type (ABO blood group as well as rhesus factor) is different from her baby’s, she may produce antibodies that can cross the placenta which then breaks down a newborn’s blood cells quickly.  This can cause more bilirubin to be formed.
• Bruising during birth.Significant bruising to newborn during delivery may lead to a higher level of bilirubin from the breakdown of more red blood cells.
• Breast-feeding.Poor feeding or insufficient milk intake from breastfeeding can lead to dehydration that increases the risk of jaundice in the first few days of life. The presence of hormonal and immune substances in breast milk can also lead to jaundice. Nonetheless, this should not stop you from breastfeeding since benefits from breast-feeding far outweigh the risk of neonatal jaundice.
• Infections: Some infections can also cause jaundice in newborns.

Is neonatal jaundice harmful?

Under normal circumstances, bilirubin levels will peak at around day 3 – 5 after birth with a total bilirubin level of not more than 15 mg/dL. In most cases, neonatal jaundice is not harmful where visible yellowing of the skin generally resolves by week-1 in a full term newborn and by week-2 in a preterm newborn.

Nevertheless, 8 to 10% of newborns may experience excessively high concentrations  of bilirubin in blood, with levels exceeding 17 mg/dL whereas 1 to 2% may have levels above 20 mg/dL.

Bilirubin in its unconjugated anionic form is toxic to the nerve cells hence excessive accumulation in the central nervous system (brain and spinal cord) can cause bilirubin encephalopathy which is associated with brain damage and hearing loss.

Signs and symptoms of bilirubin encephalopathy

Newborns with bilirubin encephalopathy may show the following symptoms, although some of these are non-specific signs that can be indicative of other conditions:

• Decreased alertness or difficulty waking up
• Poor feeding
• High-pitched crying
• Fever
• Unusual eye movements
• Arching of the neck and trunk
• Seizures, coma (late stage)

What should I do if I think my child is suffering from neonatal jaundice with or without bilirubin encephalopathy?

Seek immediate medical attention. A blood test will be carried out to determine newborn’s blood bilirubin level. Excessive levels of bilirubin in the blood may require:

• Phototherapy: The newborn will be exposed to blue light that converts bilirubin in the skin to a harmless form that can be excreted in the urine.
• Exchange transfusion: In severe cases, newborn’s blood has to be slowly replaced with fresh donor blood to remove the excessive bilirubin.

You should not try to treat the neonatal jaundice at home using:

• Herbal medicines
• Chinese medicines
• Pearl powder
• Goat’s milk.

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References:

• National Collaborating Centre for Women’s and Children’s Health (UK). Neonatal Jaundice. London: RCOG Press; 2010 May. (NICE Clinical Guidelines, No. 98.) 2, Introduction.Available from: https://www.ncbi.nlm.nih.gov/books/NBK65113/
• Lauer BJ, Spector NJ: Hyperbilirubinemia in the newborn. Pediatr Rev 2011;32:341
• Ullah S, Rahman K, Hedayati M (2016) Hyperbilirubinemia in Neonates: Types, Causes, Clinical Examinations, Preventive Measures and Treatments: A Narrative Review Article. Iranian Journal of Public Health 45(5):558-568.

In collaboration with Dosing Health

Written by

John Tiong, MPharm, RPh