Neonatal Jaundice Therapies: Treatment Options for Newborn Jaundice

Neonatal jaundice is the yellowing of a newborn's skin and eyes, which is caused by high levels of bilirubin in the blood. Bilirubin is a yellow pigment released into the blood when red blood cells break down as part of their normal lifecycle. In most newborns, the liver is not fully mature and is not effectively processing the bilirubin, leading to a short-term buildup of bilirubin.

Neonatal jaundice is very common; it affects almost 60% of full-term babies and 80% of premature babies within their first week of life (source: WHO). Most cases can be expected to go away on their own, but knowing when to diagnose and to provide neonatal jaundice treatment (if needed) is important for the safety, health, and well-being of the baby.

Mild jaundice may be considered normal; however, not every case can be disregarded. Whether or not to treat a case of jaundice will depend on several variables:

• The age of the baby (in hours and days)
• The level of bilirubin
• The presence of symptoms, for example, poor feeding or lethargy.
• Premature birth or health concerns.

When bilirubin is over the normal threshold or if the level is rising quickly, a treatment will be considered. Doctors may suggest the initiation of therapy when:

• Yellowing is noted in the first 24 hours of the baby’s life.
• Severe jaundice worsens after the third day of life.
• The baby is feeding poorly, manifesting lethargy, or excessively sleepy.
• There is the risk of kernicterus, a rare type of brain damage from severe jaundice.

In these types of scenarios, the introduction of neonatal jaundice therapies and implementation would occur immediately to help prevent further complications.

There are numerous novel neonatal jaundice therapies that are medically approved. The rate of therapy is dependent on the severity and cause of jaundice. Here are the most common and effective ones:

1. Hydration and Feeding Support

   • The bilirubin should be flushed out in the stool and urine if the infant is nursing or drinking formula.
   • Babies with jaundice may be extremely sleepy and have trouble feeding. Regular feeding must be encouraged.
   • Staying hydrated will support liver function, which will always help reduce bilirubin quickly.
   • In mild cases, this may be the only treatment required.

2. Phototherapy

   • This is the most common and effective therapy for neonatal jaundice.
   • Phototherapy is the use of a special blue light to break down excess bilirubin in the baby’s system.
   • The light changes the structure of bilirubin so that it can be excreted in both the urine and stool easily.
   • Hospital phototherapy can be done with overhead lights or fibre-optic blankets.
   • There is also the option of home phototherapy, with supervision for mild to moderate cases.
   • The baby’s eyes are covered with a protective eye-patch, and sessions are usually done for 1–2 days.

3. Intravenous Immunoglobulin (IVIG)

   • Used when jaundice is due to blood group incompatibility (Rh or ABO mismatch).
   • VIG works by decreasing the breakdown of the baby’s red blood cells and, therefore, the amount of bilirubin.
   • It can decrease the risk of needing an exchange transfusion for high-risk babies.
   • IVIG is infused via IV and will be monitored in a neonatal intensive care unit (NICU).

4. Exchange Transfusion

   • Exchange transfusion is a life-saving therapy for severe or dangerously high bilirubin levels (rarely needed).
   • The baby's blood is slowly exchanged with donor blood.
   • This effectively lowers bilirubin levels immediately and clears maternal antibodies attacking the baby’s red cells.
   • It is a very invasive procedure and is only conducted under strict medical oversight.

Mild jaundice cases in infants, under complete medical supervision, can be very successful at home. Parents need to remain alert and committed to the procedure for the child and should track behaviours, together with clinical guidance.

Key steps include:

• Maintaining consistent feedings (8-12 times daily) can increase regular poops, eliminate bilirubin levels, and ultimately, in time, assist in promoting health.
• Monitor whether a baby’s skin & eye colour are changing daily in natural light, and check to see if any yellowing spreads outside of the chest area to arms or legs, which can help to support potential assessment.
• A regular sleep cycle and feeding schedule should be promoted to prevent dehydration and make liver functions easier.
• Whenever there is a need for hydration, breast milk or formula should also be offered.
• Due attention should be paid to any sign of poor feeding, lethargy, or worsening jaundice, and a doctor or paediatric hospital should be contacted if any of these signs are seen.

Following up with your paediatrician would be the best way to ensure that any possible medical or developmental issues are treated as soon as possible to assist the child.

Consistent follow-up after treatment assists in ensuring that serum bilirubin remains in a safe range. Here are key aspects of follow-up care:

• Bilirubin Level Recheck:

  Follow-up blood or transcutaneous testing can be done within 24–48 hours of the treatment, particularly where initial levels were significantly elevated or borderline.

• Watch for Recurrence:

  Parents should watch their infant for indicators such as yellow sweat becoming deeper in their skin or whites of their eyes, if feeding isn’t regular, or if they are drowsy or act differently.

• Feeding Assessment:

  Parents should keep a close watch on their infant’s feeding, and ensure that urine/stool output is present to attempt to assure that they are excreting bilirubin.

• Developmental Checks:

  In severe cases or situations that warranted treatment, doctors may follow neurological development to rule out alterations typically associated with significant hyperbilirubinaemia.

• Timely Doctor Visits:

  Following up with your paediatrician will be the best way of ensuring that any possible medical or developmental issues get treated as soon as possible to aid the child's recovery.

Neonatal jaundice is common and nothing to worry about– but knowing when to get help will always make the difference. Whether it is phototherapy, IVIG, or feeding support, all treatments for neonatal jaundice aim at safely reducing bilirubin and reducing the chance of complications.