Jaundice in Newborns, Research Paper Example

Abstract

 Jaundice results from abnormal bilirubin levels and is characterized by a yellow skin pigment. It is normal for a newborn’s bilirubin levels to be high after birth due to natural low liver function and this is expected to be resolved within two weeks. Although jaundice is expected in some pediatric patients, this condition could worsen in response to certain medications, abnormal blood cells, and infection, among other causes. It is essential to define the symptoms that healthcare professionals and parents should recognize to diagnose this disorder. Furthermore, it is essential to be familiar with clinical tests such as complete blood counts (CBC), the Coomb’s test, and Reticulocyte counts that are used to confirm presence of an excess of bilirubin and determine the physiological impacts experienced by the patient. Treatment is typically not needed but may be necessary in extreme cases. However, if the jaundice does not disappear in one to two weeks, the child is at risk for brain damage. Therefore, newborns with jaundice should be regularly examined until the symptoms dissipate.

Introduction

Jaundice is an illness that is characterized by yellow skin and can occur in both adult and pediatric patient. This primary symptom results from liver dysfunction, which could stem from other disorders such as hepatitis and liver cancer. In pediatric patients with the disease however, jaundice is commonly observed and does not typically pose a threat to the newborn’s health. In extreme cases, however, it can lead to kernicterus, or brain damage from very high bilirubin levels. Therefore, it is essential to detail the disease symptoms to advise both parents and healthcare professionals about what can be done to monitor the disease and ensure that there are no unnecessary complications.

Jaundice occurs as a result of high bilirubin levels, which is a chemical that is produced from the degradation of hemoglobin from erythrocytes undergoing either normal or abnormal destruction with mononuclear phagocytes. When macrophages and a free heme group are oxidized by microsomal heme oxygenase into biliverdin. The iron is then released. Biliverdin reductase reduces biliverdin into unconjugated bilirubin. At this point, the unconjugated bilirubin is released into the plasma where it binds to albumin. It is then taken up by the liver. Patients with jaundice are unable to take up the bilirubin due to decreased liver function. Therefore, we observe the yellow coloration of their skin as a symptom of excess protein in their plasma.

When babies are newborn, it takes from one to two weeks for their livers to gain regular levels of function. Therefore, jaundice is seen in many of these pediatric patients. However, although symptoms are expected to disappear without treatment, extreme cases of jaundice may result in brain damage. Therefore, it is essential to conduct several clinical tests throughout the newborn’s stay in the hospital and it is occasionally recommended that these tests be continued regularly after the child is sent home with his or her family. The complete blood count (CBC) measures levels of erythrocytes (red blood cells), leukocytes (white blood cells), and thrombocytes (platelets). This test will not indicate the cause of the jaundice, but is useful for determining the presence of sepsis, anemia, hemolysis, and hemorrhage. The Coomb’s test is used specifically in newborns with jaundice. Healthcare professionals will take a sample of the child’s blood and test it for antibodies against his or her red blood cells to determine whether hemolysis is a factor in the cause of the jaundice. Ultimately this tests Rh compatibility and ABO compatibility of the newborn and the parent. It is possible that contradictory blood types caused the jaundice and now that the baby is born, this will cease to be problematic. Lastly, a reticulocyte count is used to confirm hemolysis.

Complications from high levels of bilirubin in infants include cerebral palsy, deafness, and kernicterus. Typically, these disorders are not observed because increased levels of bilirubin are detected early and dealt with before it can cause an issue. To reduce jaundice, there are several treatment options available. Firstly, feeding newborns every two to three hours is a useful way to treat the symptoms without use of medicine. However, if the discoloration symptom persists, it may be necessary to use phototherapy with or without a BiliBlanket. Phototherapy eliminates bilirubin in the blood by emitting light waves that the newborn’s skin and blood will absorb. This triggers the conversion of the bilirubin to metabolic products that can be excreted. The BiliBlanket is a similar treatment method that can be used individually or in combination with phototherapy. This treatment method works similarly to phototherapy, but utilizes waves that are similar to those emitted by natural sunlight.

While much is known about jaundice in newborns, researchers continue to evaluate the causes and consequences of these cases. Therefore, it is useful to evaluate the literature to determine where treatment of this disorder can be improved. A review of relevant literature will therefore be discussed below.

Discussion

A 2004 article entitled “A Method for Interdicting the Development of Severe Jaundice in Newborns by Inhibiting the Production of Bilirubin” discusses a treatment process that involves preventing a bilirubin overload before disease symptoms are see in the patient (Kappas 119). Specifically, this method involves using an inhibitor that is targeted directly at the enzyme that controls heme degradation to bilirubin. Therefore, implementation of this method will drastically reduce the number of neurotoxic effects that occur due to abnormally high bilirubin levels. Furthermore, it is possible that this method can be useful for all babies one to two weeks after birth to act as a liver replacement until their own becomes active.

Second, current studies of jaundice emphasize the importance of tracking patients with jaundice through the first few weeks of their lives. An article entitled “Readmission for Newborn Jaundice: The Value of the Coombs’ Test in Predicting the Need for Phototherapy” attempts to simplify this process by explaining that the Coomb’s test is a useful measure of the need for treatment (Madan et al. 63). This project attempted to determine which methods among those used to detect adverse effects related to bilirubin levels in newborns are necessary. It was found that the Coomb’s test is sufficient for doing so. Therefore, even though other tests, such as CBC are useful for tracking the health of the patient, they are not helpful in detecting potential neurotoxic effects. Despite this finding, it is useful to collect as much laboratory data as possible on these patients in order to gain a complete understanding of their special cases.

An article entitled “Kernicterus: Epidemiological Strategies for Its Prevention through Systems-Based Approaches” discusses the epidemiology of one of the most severe physiological consequences of jaundice in newborns (Bhutani et al. 650). These researchers state that kernicterus is completely avoidable and due to the devastating health status of newborns with the illness, action should be taken to ensure that it is prevented. Despite the commonality of jaundice in newborns the incidence and prevalence of the disease has not yet been studied in detail. Furthermore, we are unaware of the incidence and prevalence of severe disease symptoms, such as cerebral palsy, deafness, and kernicterus. Therefore, there are many gaps in knowledge that must be filled. Researchers nearly perfectly understand the mechanism that causes jaundice in newborns, so it is essential to take advantage of this knowledge to improve understanding and detection of the disease in addition to more useful treatments.

While we understand the mechanism that causes high levels of bilirubin in newborns, researchers do not know what causes this. It is known that liver function in newborns is minimal, but infants exhibit varying degrees of jaundice and it would be useful to determine what is responsible for causing the more extreme cases. An article entitled “Can Anesthesiologic Strategies for Caesarean Section Influence Newborn Jaundice?” attempts to elucidate this cause (De Amici et al. 97). The researchers found that anesthetic techniques used likely contribute to the cause of jaundice in newborns. Therefore, it is necessary to evaluate this cause further to elucidate a mechanism of action. As mentioned in the introduction, hepatitis and certain cancers are causes of jaundice in adults. While it is unlikely that the infant was born with these specific conditions, it is possible that a genetic disorder inherited by the child plays a significant role in disease development. Therefore, it is necessary for to discover other disease risk factors. Doing so will increase the ability of healthcare professionals and parents to care for their child because knowledge of the risk factor will allow the jaundice to be predicted before the birth of the child. In doing so, everyone involved will be ready to care for the newborn with the understanding that treatment will be necessary.

Conclusion    

Jaundice in newborns is considered a curable disease, but many infants with high bilirubin levels in their blood experience extreme neurotoxic symptoms that result in cerebral palsy, blindness, or kernicterus. Therefore, there is an existing need to fill gaps of knowledge in this field. While phototherapy with or without use of the BiliBlanket successfully breaks down bilirubin in the plasma, it may be useful to employ other methods, such as the targeted degradation of this protein using an antibody. Furthermore, despite the commonality of jaundice in newborns, epidemiologists have made few attempts to characterize the disease according to demographics. Since a complete set of risk factors for this disease have yet to be determined, it would be useful to conduct these epidemiological studies in order to gain more information that can be used for this purpose. Until we can discover more information about this disease, it is essential for physicians to request that newborns with jaundice be examined regularly in the hospital setting in addition to regular office visits after the child is approved to return home. Early detection is essential in preventing the neurotoxicity’s related to jaundice and until an easier method is devised, the child must be examined closely for jaundice during their first two weeks.

Works Cited

Bhutani V et al. “Kernicterus: Epidemiological Strategies for Its Prevention through Systems-Based Approaches”. Journal of Perinatology 24. 2004: 650–662. Print.

De Amici D et al. “Can anesthesiologic strategies for caesarean section influence newborn jaundice? A retrospective and prospective study.” Biol Neonate 79. 2 2001: 97-102. Print.

Kappas A. “A Method for Interdicting the Development of Severe Jaundice in Newborns by Inhibiting the Production of Bilirubin”. Pediatrics 113. 1 2008: 119-123. Print.

Madan A, Huntsinger K, Burgos A, Benitz WA. “Readmission for Newborn Jaundice: The Value of the Coombs’ Test in Predicting the Need for Phototherapy”. Clinical Pediatrics 53. 5 2004: 63-68. Print.