Distinguish between physiological neonatal jaundice and pathological jaundice

This is an automatically translated article.

The article was professionally consulted by BSCK II Bui Minh Phuc - Department of Obstetrics and Gynecology, Vinmec Ha Long International Hospital.
Jaundice is a phenomenon where red blood cells are broken, the liver's bilirubin metabolism function is not complete. Pathological jaundice in newborns can cause neonatal jaundice, which can lead to death or retardation of the child's development. Therefore, mothers should be aware of some signs to distinguish physiological neonatal jaundice and pathological jaundice.

1. Distinguish physiological and pathological jaundice

In neonates, there may be physiological jaundice or pathological jaundice. Physiological jaundice will usually disappear after a short time. Meanwhile, if you have pathological jaundice, it will be very dangerous because the child may go into a coma, convulsion, so parents need to know how to detect jaundice in a newborn.

1.1. Physiological Jaundice Physiological jaundice can be mild, in term infants, normal jaundice is considered physiological when jaundice appears after 24 hours of age, and usually disappears within 1 week in infants term and 2 weeks in preterm infants.
Mild degree of jaundice is only jaundice (yellowing of the face, neck, chest and abdomen above the navel) without other abnormal symptoms (anemia, hepatosplenomegaly, abortion, lethargy, duh,...). Bilirubin/blood concentration is not more than 12mg% in term infants and not more than 14mg% in preterm infants,... Bilirubin/blood rise rate is not more than 5mg% in 24 hours. In addition, the infant's urine is dark or yellow (infant urine is usually colorless) and the stool is pale.
The cause of physiological jaundice in newborns is the accumulation of Bilirubin, a yellow substance produced when red blood cells are broken down. This phenomenon is common in newborns because they have high levels of red blood cells, which are often broken down and replaced. Meanwhile, the baby's liver is not mature enough to remove all bilirubin from the blood, thus causing jaundice. When the baby is about 2 weeks old, the liver has developed more fully and is able to process Bilirubin, so jaundice will go away on its own without causing any danger


1.2. Pathological Jaundice In some cases, jaundice is a manifestation of an underlying disease and in these cases the jaundice will appear as early as 24 hours after birth. The pathology is dark jaundice appearing early, not yellowing after 1 week for full-term infants and 2 weeks for preterm infants, the degree of yellowing of the whole body, palms, feet and even the conjunctiva of the eyes. Simultaneously with jaundice, there are other abnormal symptoms such as: lethargy, lethargy, convulsions,... Bilirubin blood test is higher than normal. If not detected and treated, gold Neonatal skin disease can lead to neurotoxic complications due to low indirect Bilirubin entering the brain causing death or lifelong brain damage. Some causes of neonatal jaundice include: mother-child blood group (ABO, Rh), hemolytic disease (G6PD deficiency, sickle cell disease, infection), subcutaneous hemorrhage, meconium delay, fetal viral infection, congenital hepatobiliary disease (bile duct atrophy, biliary dilatation).

2. Signs children need to see a doctor

When a child has one of the following signs, parents should take the child to a medical facility to examine and find the cause of jaundice in time.
Jaundice appears early before 48 hours postpartum. Gold in the whole body, yellow in the palms and soles of the feet. Jaundice lasts for more than 1 week in term infants, more than 2 weeks in preterm infants. Children with jaundice with other abnormal signs such as less feeding, convulsions, fever, discolored stools, ... Jaundice is very easy to recognize with the naked eye in a place with enough light. Therefore, every day mothers need to observe the skin color of the child's whole body in a bright place. In difficult cases (the child's skin is red, pink or black), gently press the thumb on the child's skin for a few seconds, then let go, if the child has jaundice, the place where the finger is pressed will have a distinct yellow color. When a child shows signs of jaundice, parents need to take the child to the doctor for examination.

3. Prevention of neonatal jaundice

Take good care of your health during pregnancy, have a full antenatal check-up by appointment so that you can detect and promptly treat diseases during pregnancy. Thereby avoiding premature birth, low birth weight, overweight, infection from mother to child. Breastfeed your baby with colostrum right after birth and keep the baby warm to prevent hypothermia, low blood sugar, and meconium early right after birth. The baby's room must have enough light so that the baby's skin color can be easily monitored. There are 2 methods to treat pathological neonatal jaundice caused by indirect increase of Bilirubin:
Phototherapy is a simple, safe and effective treatment method. The goal of this method is to use light energy through the skin to help convert free Bilirubin in the blood into other non-toxic substances, excreted in feces and urine. When illuminating the light, the child will be stripped of his bare clothes, covering his eyes and genitals, and turning to increase the area of ​​the skin exposed to light. Blood exchange is a measure used when children with severe jaundice have failed to treat with phototherapy or have accompanying neurological symptoms. Note: Exposing children to the sun in the morning does not help treat pathological jaundice because the light intensity of early sunlight is too weak and children cannot be exposed to sunlight for a long time to achieve the effect.
For the treatment of pathological neonatal jaundice caused by direct elevation of Bilirubin, there are different treatment methods depending on the pathological cause. Surgery if the child has biliary atresia or congenital biliary dilatation.

Please dial HOTLINE for more information or register for an appointment HERE. Download MyVinmec app to make appointments faster and to manage your bookings easily.