My son will be four week’s old tomorrow. This is my first child born through C section. He feeds well and even sleeps quite long for a new born in the night. However, I have noticed a yellowish colour in his eyes that is really beginning to worry me. I noticed this change about a week ago. 

My aunt says that his eyes will clear as he grows. I feel like he lacks something. He doesn’t feed on anything other than breast milk. But his eyes seem to be getting ‘yellower’. What causes this? Should I be worried?

Jane

Dear Jane

Your baby seems to be suffering from neonatal jaundice. Over 50 per cent of infants suffer from physiological jaundice which is harmless.  The risk is more with pre term babies and boys.  It causes yellow discoloration of the skin and sclera (white portion around eyes) and usually occurs within the first week of life. Rarely may it occur in a slightly older baby.  The jaundice in new borns occurs due to high levels of bilirubin.

Bilirubin is the waste product that remains after red blood cells break down and release hemoglobin (protein present in the red blood cells). During pregnancy, bilirubin of the fetus is removed by the mother’s liver. However after birth of the child, fetal break down of red blood cells and replacement by new ones becomes fast, exceeding the capacity of the liver to remove it. Also, lack of adequate gut flora which helps in intestinal metabolism and removal of bilirubin also contributes to this jaundice. 

Rarely, some infants develop jaundice due to a mother’s milk. Some factor in a mother’s milk prevents adequate metabolism of bilirubin.

Sometimes   neo natal jaundice may be caused by congenital disorder of the red blood cells which causes their excess breakdown. Different blood groups of the mother and baby (Rhesus incompatibility) may also cause excess breakdown of the red cells of blood, resulting in jaundice.  

Enzyme defects, blocked bile ducts, sepsis due to bacterial infections, syphilis, toxoplasmosis, inflammation of the liver are some other conditions which can cause jaundice in a new born. However in these pathological conditions, jaundice would be associated with features of underlying disease. Moreover feeding of the child will be affected.

There is nothing to worry about in the case of physiological jaundice in a new born, because it tends to go as the infant grows and the liver becomes more mature. Rarely, very high levels of bilirubin can affect the brain causing brain damage. Keeping the baby in a room with sufficient sunlight also helps to reduce jaundice, (but avoid exposure to direct sunlight as strong sunlight can burn the delicate skin of the child). If jaundice is persistent or is profound, phototherapy is used to reduce the high levels of bilirubin.

In case of sepsis or non bacterial infections causing jaundice in a new born, treatment by suitable antibiotic is beneficial. Babies having jaundice due to blood group incompatibility benefit from intravenous immune globulin. In case of children having abnormality of the red blood cells or where other modalities of management fail, exchange transfusion is used.

Active bowel movements of the baby also help in removing excess bilirubin and reducing jaundice. Starting breast feeding early and giving frequent feeds helps the baby in this regard.

Dr. Rachna is a specialist in internal medicine at Ruhengeri Hopsital