NEONATAL JAUNDICE IN THE NEWBORNS

NEONATAL JAUNDICE
Hyperbilirubinemia occurs in nearly all newborns and can be classified in several categories, including pathologic jaundice, physiologic jaundice of the newborn, breastfeeding jaundice, and breast milk jaundice.

Pathologic jaundice: Jaundice in the first 24 hours after birth is not normal, and causes such as sepsis and blood type incompatibility should be sought.

Physiologic jaundice: Physiologic jaundice is due to a higher erythrocyte circulating volume, a larger amount of precursors that undergo early degeneration, and a shorter life span of the newborn's erythrocytes. In addition to these physiologic considerations, the newborn hepatic uptake and conjugation of bilirubin are reduced, and the reabsorption of bilirubin is relatively enhanced due to a process called enterohepatic recirculation. These factors can lead to an early elevation in unconjugated bilirubin levels, which typically become normal adult values when the neonate is aged 2-3 weeks.

Breastfeeding jaundice: In addition to physiologic jaundice, breastfeeding jaundice or dehydration jaundice may develop in infants who breastfeed. Breastfeeding jaundice is due to inadequate milk intake, regardless of the cause. This condition occurs in the neonate's second or third day of life, usually before the mother's milk supply is in.

The treatment is to put the infant to the breast more frequently, and the mother-infant dyad should be observed for proper latch-on. Maternal pumping with supplementation should be considered only if increasing the breastfeeding frequency does not lead to an increased milk supply. Evaluation of the overall nutritional status and breastfeeding technique of the mother-infant dyad is essential for successful lactation and the resolution of breastfeeding jaundice.

Breast milk jaundice
Breast milk jaundice is different from breastfeeding jaundice in that unconjugated bilirubin levels in the serum continue to increase during the first 2 weeks. With breast milk jaundice, the unconjugated bilirubin level typically peaks between days 5 and 15 after birth, and they usually return normal levels by the end of the third week. However, elevated levels that persist into the third month are not uncommon.

Interrupting breastfeeding in an otherwise healthy infant is not recommended unless the serum bilirubin concentration exceeds 20-22 mg/dL. The cause of breast milk jaundice is still not clear, an inhibitor of hepatic glucuronyl transferase is thought or exists, and/or the enterohepatic circulation of bilirubin increases. Other more rare forms of unconjugated hyperbilirubinemia, such as Crigler-Najjar syndrome (ie, glucuronyl transferase deficiency), should be considered if the bilirubin level remains elevated after the infant's first month of life.