Jaundice in Premature Babies

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What is jaundice? – Jaundice is yellowish colouration of the skin and white portion (sclera) of the eyes. It is common in newborn babies but more common in premature babies (born before 37 weeks). The earlier than 37 weeks a baby is born (especially below 35 weeks), the more likely it will have jaundice. This occurs in almost 8 out of 10 babies born prematurely. 

How does jaundice develop?

Jaundice arises from accumulation of bilirubin (a waste product of red blood cell destruction) in the blood. Bilirubin is metabolised by the liver, converting it from a complex form to a simple form that can be excreted from the body either in stool or urine.

When it is not metabolised or it is metabolised slower than it is produced, it accumulates in the blood and appears yellow on the skin and the white portion of the eyes (sclera) because bilirubin is yellow in colour. 

Why do preterm babies have jaundice?

Jaundice develops in premature babies due to the immaturity of the liver which is supposed to metabolise bilirubin generated from red blood cell destruction. The earlier than 37 weeks a baby is born, the less the ability of the liver to metabolise bilirubin and the higher the tendency to have jaundice. 

How does jaundice manifest in premature babies?

Jaundice manifests as yellowish colouration of the skin and sclera. This can be noted by applying gentle pressure (blanching) on the skin of the forehead or the nose. If there is jaundice, the skin appears yellow. Otherwise, the skin appears pale (light coloured) for a while before returning to normal. The baby may be irritable, have poor feeding habit and poor weight gain.

How to check for severity of jaundice?

The severity of jaundice can be objectively assessed by checking the level of bilirubin in the blood in a laboratory. The level determines the need for treatment and the modality of the treatment required. 

What are the treatment options for jaundice in premature babies?

Jaundice in premature babies, unlike term babies, usually requires some form of treatment, which may be phototherapy (putting the baby under special light) or exchange blood transfusion.

  1. Phototherapy – The affected baby is placed under special light. The eyes are covered by opaque eye glasses or other protective materials while the skin is exposed to the light with only the genitals covered with diapers. The light shines on the skin and helps convert bilirubin from the form which cannot be excreted until metabolised by the liver to the form which can be excreted in faeces or urine without waiting to be metabolised by the liver. Bilirubin level is checked at least every 24 hours to ascertain the effectiveness of treatment, evidenced by reduction in its value. 
  2. Exchange blood transfusion – This entails gradual removal of the baby’s blood while replacing it with donor blood. This helps by removing the baby’s blood with high content of bilirubin and replacing it with normal blood. 

Complications of jaundice in premature babies

These are complications that can occur with jaundice in neonates generally. They include:

  1. Seizure disorder
  2. Cerebral palsy
  3. Bilirubin encephalopathy / bilirubin-induced neurologic damage (kernicterus)

Prevention of jaundice in premature babies

Measures that prevent preterm delivery will go a long way in preventing jaundice in newborn babies. Also, self-medication in pregnancy should be avoided as this may lead to undue increase in red blood cell destruction in the newborn, thus leading to increase in bilirubin production. 

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