Newborn Yellow infant. A yellow infant is a newborn in which the color of the skin and the whites of the eyes are colored yellowish. This color is caused by an excessive amount of bilirubin in the blood. Bilirubin is a breakdown product of red blood cells, which is removed from the body via the liver. The medical term for a yellow infant is icterus neonatorum. Icterus means jaundice and neonatorum means newborn. An infant’s yellowness is usually normal and harmless (physiological), but may occasionally also be abnormal (pathological).
Physiological yellow infant
All newborns have an increased level of bilirubin in the blood between the second and seventh days of life. In half of the newborns, this is visible on the skin or the whites of the eyes, often around the third day. This is a normal phenomenon and is called physiological jaundice neonatorum.
Pathological yellow infant
A yellow color that developed before the second day of life or after the seventh day of life is not normal. This also applies to a bilirubin value in the blood of more than 210 micromoles per liter. Then we speak of a pathological icterus neonatorum. This is more often seen in premature children than in full-term children.
Symptoms in a yellow infant
You can recognize a yellow infant because the color of your newborn child’s skin is not pink-red, but yellow to yellow-brown. The whites of your child’s eyes are then not white in color, but also colored light yellow. A yellow color slightly between the second and seventh day of life is normal and not disturbing. If the amount of bilirubin in your child’s blood gets too high, your child’s yellow color will increase and your child may experience the following symptoms:
- your child is drowsy and sleepy and never really wakes up during the day;
- your child drinks less well;
- your child feels very weak;
- your child is very restless and cries very loudly and in high tones.
The maternity nurse, midwife or nurse in the hospital will assess the color of your child every day. If you are concerned about your child’s color, you can discuss it with them.
How come an infant turns yellow?
Bilirubin is a substance that is mainly released during the breakdown of red blood cells. This is a normal process. Red blood cells are broken down and produced continuously in the body. The bilirubin is transported through the blood to the liver. The liver ensures that it is removed from the body through the bile with the stool.
Physiological yellow infant Before birth, the child’s bilirubin is delivered through the placenta to the mother’s blood. The mother’s liver excretes bilirubin in the mother’s stool. After birth, your child’s liver must remove the bilirubin from the body itself. Each newborn’s liver has to get used to this new function, so that the level of bilirubin in the blood in all newborns is increased for several days.
Pathological yellow infant. In premature children, the liver has not yet matured sufficiently, which often causes the liver to have more problems processing bilirubin. Therefore, icterus neonatorum is more common in preterm infants. In addition to premature birth, there are a number of situations in which the bilirubin level in the blood becomes higher than normal. For example, with an increased breakdown of red blood cells (including rhesus antagonism) or a blockage of the bile duct.
Is it serious and what can you expect?
Some yellowing between the second and seventh day of life is a normal phenomenon and does not cause any problems for the health of your child. However, if the bilirubin level in your child’s blood gets too high (more than 210 micromoles per liter of blood), problems can arise. The likelihood of problems also depends on the age of your child, the gestational age, the day on which the bilirubin level reaches this value and the overall condition of your child. Different values may apply to preterm children.
Yellowing of certain brain nuclei A serious complication in a pathological yellow infant may be yellowing of certain brain nuclei. This is called kernicterus. The likelihood of this increases sharply if the bilirubin level in the blood exceeds 340 micromoles per liter. These cores damage, causing the child to have serious problems such as deafness, spasticity and developmental delay. Fortunately, as the color of newborn children is closely monitored these days, these problems are rare.
Examination of the bilirubin level It is therefore very important that too high a level of bilirubin in your child’s blood is recognized and treated early. The maternity nurse, midwife or nurse in the hospital will therefore keep a close eye on your child’s color. If they suspect that the bilirubin level in the blood is too high, your child will have blood tests taken at the hospital to determine the value of the bilirubin level. If the bilirubin level is too high, your child will be referred to the pediatrician in the hospital. The pediatrician will examine your child for a cause of the high bilirubin in the blood. Sometimes the choice is made to reassess the bilirubin level in the blood four to six hours later. This is to determine the rate at which bilirubin levels rise.
See also, Dyslexia in children
Treatment Your child will need to be admitted to hospital for treatment. There are two possible treatments for bilirubin levels that are too high:
- light therapy;
- exchange transfusion.
Depending on your child’s weight, the day of treatment to be started, the cause of the excessive bilirubin level and the general condition of your child, one of these two treatments will be chosen.
Light therapy (phototherapy) For the light therapy, your child is usually placed in the incubator without clothes on, so that the largest possible surface of the skin is exposed. A blue lamp is placed above the incubator that emits special light. This light is able to convert bilirubin into other substances that can be excreted from the body through the bile or through the urine. The blue lamp is on all day and night. To protect your child’s eyes, your child will receive a dark patch for the eyes.
Your child may be removed from the incubator for feeding. Blood will be tested regularly to check the value of the bilirubin, to see if the treatment is working. The treatment lasts at least 24 hours, but may also be necessary for several days.
Based on the blood bilirubin value, the pediatrician will determine how long it takes your child to stay under the blue light. If light therapy fails to sufficiently lower bilirubin, it may be necessary to use an exchange transfusion. The light therapy is not harmful to your child. Sometimes your child’s skin becomes a little red and irritated by the light therapy. This disappears after the light therapy has stopped.
Exchange transfusion In severe forms of pathological jaundice neonatorum, an exchange transfusion is required. This also happens in the hospital. The pediatrician inserts a catheter through the blood vessels in your child’s navel. A number of times a portion of your child’s blood is taken through this catheter and replaced with donated blood. For example, your child’s blood with an excess of bilirubin will be replaced by blood with a normal level of bilirubin. Your child’s bilirubin level will drop as a result.
Sometimes it is necessary to repeat this treatment at a later time, when it turns out that the bilirubin level in the blood becomes too high again. That is why your child will stay in the hospital for a few days after the treatment. During and after this treatment, your child will be closely monitored and it will be on a monitor that monitors your child’s heart rate, blood pressure and oxygen levels. Usually this is done in a medium or intensive care unit for newborns. Fortunately, complications from this treatment are rare.
Consequences for later age If a high bilirubin level is detected in time and treated in the above way, it has no consequences for the health and development of your child now and in later age.
When to the doctor?
If you feel that your child is too yellow, you can discuss this with the maternity nurse, midwife or your GP. They can therefore assess the color of your child. When in doubt, they will ensure that your child has blood samples to determine the bilirubin level.
It is extra important to discuss this if your child is already yellow within 24 hours after birth.
What can you do about it yourself?
If your child turns yellow between the second and seventh days, you can put your child in the outside light behind the window. As with phototherapy, the outside light can also cause the bilirubin to be broken down. If the maternity nurse, midwife or nurse in the hospital suspects that your child is turning too yellow and blood tests confirm this, hospital treatment is necessary. It is usually also possible to be admitted yourself, so that you can stay close to your child.
General advice and precautions for a yellow infant
You cannot prevent your child from getting bilirubin levels that are too high.
Breastfeeding By breastfeeding a yellow color in your child may last longer, because breastfeeding stimulates the re-absorption of bilirubin from the stool in the blood. However, this is never a reason to stop breastfeeding.
Next pregnancy Depending on the cause of the high bilirubin level in the blood, any subsequent child may also have a high bilirubin level. That is why it is important to always report this to the obstetrician or gynecologist who supervises your pregnancy and delivery. He or she can then be extra alert to the color of this child.
Rhesus antagonism To prevent Rhesus antagonism, one of the possible causes of pathological jaundice neonatorum, you will receive an injection of anti-D if you are Rhesus negative and have given birth to a Rhesus positive child.
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