Jaundice
Physicians are trained to look for visible signs of illness. These can be physical deformities, stereotypical facial characteristics, skin changes, and a multitude of others. Today, we discuss jaundice, a very noticeable physical manifestation of disease.
What is jaundice?
Jaundice is a yellow-colored tint to the skin and eyes that is caused by a chemical called bilirubin. Bilirubin is released into the blood when red blood cells are naturally broken down. In healthy people, this chemical is removed from the blood by the liver easily and does not cause harm. In newborns, it is often noticeable because it can take few days after birth for the liver to be able to fully respond to this chemical, and therefore bilirubin can build up, causing the skin to turn yellow. In older children or adults with certain blood or liver disorders, this yellow color can be an important sign of liver dysfunction and worsening illness.
In newborns, jaundice is more common and may be more prolonged in infants who are breastfed. Newborns may need to have levels of bilirubin checked frequently after birth to make sure they do not need treatment to bring the levels down to a safe level. Jaundice is a significant concern if it is present in the first 24 hours of life, and further investigation into the possible causes is necessary.
In older children jaundice is never normal. It can be a sign of liver disease or an obstruction of the biliary ducts (parts of the liver that drain bile into the intestines. Common causes of jaundice in these children are liver infections such as hepatitis B or C, autoimmune hepatitis, gallstones, cirrhosis (late stages of chronic liver disease), or Wilson disease (a genetic condition in which copper accumulates in the liver). Yellow color to the skin or eyes in older children should always prompt a full evaluation of the liver and it’s functioning.
Is jaundice harmful?
It can be, but it depends on the age of the patient, the situation in which jaundice is occurring, and the level of bilirubin.
In newborns, we use a graph to determine when treatment needs to be started versus when we can just “wait and see.” This level depends on several factors, using the age in hours of the infant and any risk factors to determine treatment thresholds. The risk factors that cause higher concerns in newborns include prematurity, blood type differences between mother and baby, severe illness or infection in infant at birth, and family history of certain blood disorders.
Rising levels of bilirubin can be harmful because at very high levels this chemical accumulates in the brain. This causes a condition called kernicterus, a neurological condition that can cause irreversible damage to parts of the brain, leading to developmental delays, deafness, and decreased intellectual ability.
How is it treated?
In newborns, mild jaundice does not require treatment. Over time, the liver function improves and takes the bilirubin chemical out of the blood naturally and jaundice resolves within 2-4 weeks.
In the infants where the bilirubin levels are higher or rising quickly, jaundice will be treated with special lights, or phototherapy. This can be done in the hospital or at home, depending on the severity of the bilirubin level and the availability of treatment methods in your community.
Very high levels of bilirubin are considered a medical emergency for infants and require admission to the hospital – sometimes even the intensive care unit. These require a special type of blood transfusion called an exchange transfusion, to lower the bilirubin levels rapidly. Infants in this situation also undergo an extensive evaluation to determine the cause of the high bilirubin levels.
In older children, treatment of jaundice varies based on the treatment of the underlying condition.
Final thoughts
The visual inspection of children during a medical evaluation is one of the most important aspects of the exam. In the case of jaundice, the yellow discoloration of the skin and eyes are an immediate red flag to the physician that something may be wrong. For newborns, make sure you are following up in clinic as instructed, and obtain labs when they are ordered. Be sure to have older children evaluated right away if you think there is an abnormal hue to the skin. Kernicterus is a severe but thankfully preventable consequence that no child should have to suffer.
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