Jaundice in Babies - Treatment

Dr. Parang Mehta, MD.

Jaundice is a common problem in children, but very few of these babies actually need treatment.  However, it is not a disease to be taken lightly, because the disease can cause lifelong disability, and even death.

Laboratory Testing

Not much laboratory testing is required in jaundice.  A serum bilirubin level to know the risk to the brain, and some investigations to rule out infection are usually done in the beginning.  Only if the jaundice rises to very high levels do we order tests to diagnose the cause of the jaundice.

If jaundice is visually obvious, a blood level should be done.  Visual assessments of depth of jaundice are unreliable, and can be dangerous.

The mother's blood group should be ascertained, and the possibility of an incompatibility with the baby considered.  Tests for thyroid disease, enzyme deficiencies, metabolic disorders, etc, are also done in some children.  

Does Jaundice Need Treatment?

Jaundice is caused by the accumulation of bilirubin in the bloodstream, and this substance has the ability to cause damage to a baby's brain.  Jaundice in the newborn is one of the preventable causes of brain disorder in children.  Not the jaundice itself, but the brain damage it causes, can be prevented.

If left untreated, jaundice in babies can cause brain damage, deafness, seizure disease, mental retardation, cerebral palsy, and even death.  Jaundice in a baby should be properly evaluated, and treated urgently if indicated.

There is no one level of serum bilirubin at which all babies need treatment.  The decision to treat is based on the risk of brain damage occurring.  A full term healthy newborn can withstand a higher bilirubin level than a premature ill baby.

Phototherapy For Jaundice

This is the usual treatment for jaundice in babies.  The baby's skin is exposed to strong light (usually blue).  Traditional phototherapy units consist of banks of blue fluorescent tubes, and the baby is placed nude under the light.  A glass or other transparent sheet allows the baby to be irradiated with light from two directions (double surface phototherapy).

These days various types of phototherapy devices are available.  Halogen lamps with a high output, fiberoptic phototherapy blankets in which a baby can be wrapped, etc are as effective as traditional phototherapy.  Phototherapy works by converting the bilirubin to a water soluble compound that can be excreted by the baby in the bile and urine.

The baby's eyes are covered for phototherapy (if a male baby, the genitals too).  The baby should be kept continuously under the lights, except for brief breaks for feeding.  If the serum bilirubin levels do not reduce soon, it may be necessary to do an exchange transfusion.  

Exchange Transfusion

Before phototherapy, this was the only effective treatment for jaundice in the newborn.  Even today, if phototherapy fails, an exchange transfusion is the treatment resorted to.

An exchange transfusion is just that - the baby's blood is exchanged with that of a healthy donor.  Since the donor blood has very low bilirubin levels, the baby's bilirubin levels drop significantly after an exchange transfusion.

The procedure involves placing a catheter inside a large vein in the baby (usually the umbilical vein), and then removing a quantity of blood.  Then it is replaced with the donor's blood.  This is repeated several times, resulting in the bilirubin being washed out of the baby's body.

Exchange transfusion removes about half the bilirubin present in the baby's body in a procedure lasting under an hour.  It is thus more effective than phototherapy, but is also more risky for the baby.  There can be minor and major complications of the procedure.  In good centres, the mortality of exchange transfusion is less than one percent.

High Risk Situations

Very high bilirubin levels in the blood can cause damage to the baby's brain, leading to lifelong sequelae, and even death.  Bilirubin brain damage is an avoidable cause of mental and developmental retardation, and should not be allowed to happen.  While most bilirubin encephalopathy occurs only at high levels, some children suffer this at low levels of bilirubin also.

Last Revision: May 12, 2020