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Everything You Need To Know About Jaundice
Adults and children with jaundice may notice a yellowish tinge to their skin, mucous membranes, and the whites of the eyes. It can happen with various health conditions and usually indicates a problem with the liver or bile ducts.
When the liver is not working properly, it can cause a waste material called bilirubin to build up in the blood.
With moderate bilirubin levels, a person's skin, eyes, and mucous membranes can turn yellow. As it progresses, the color can also change from yellow to green. The green color occurs due to biliverdin, the green pigment present in bile.
Jaundice can develop in people of all ages and is normally the result of an underlying condition. Newborns and older adults have the highest likelihood of developing jaundice.
This article discusses what causes jaundice, how healthcare professionals diagnose and treat the condition, and how a person can help to prevent it from occurring. It also explores the symptoms a person can expect.
According to the American Family Physician (AAFP), jaundice is the yellowing of the skin, mucous membranes, and the whites of the eyes that occurs when the body does not process bilirubin as it should.
Bilirubin levels increase as the red blood cells naturally break down. Typically, the liver filters this waste material out of the bloodstream and turns it into a new form called conjugated bilirubin. The new form then exits the body in a person's stool.
If there is too much bilirubin for the liver to process, it can build up in the body. This is known as hyperbilirubinemia, and it causes the yellow color in the skin and eyes.
Jaundice typically occurs due to an underlying disorder that either causes the production of too much bilirubin or prevents the liver from eliminating it.
Some possible underlying conditions and causes of jaundice include:
Treatment will depend on the underlying cause of jaundice.
Jaundice can lead to itching, or pruritis. A 2021 article notes that a person can have warm baths containing oatmeal and take antihistamines for mild pruritis.
A healthcare professional may prescribe medications for those experiencing moderate to severe pruritis, such as cholestyramine or colestipol.
As jaundice may sometimes indicate damage to the liver, a liver transplant may be necessary in some cases, depending on the severity of the injury.
Jaundice is related to liver function.
People can help take care of their liver with several lifestyle changes, such as:
A 2021 article also suggests:
Common symptoms of jaundice include:
In infants, the yellowish tinge can start at the head and spread down the body to the toes.
The United Kingdom's National Health Service (NHS) notes that jaundice may be less apparent on Black and Brown skin. It is more obvious in the whites of the eyes.
Accompanying symptoms of jaundice may include:
High levels of bilirubin can be toxic and lead to a rare type of brain damage called kernicterus in infants.
The underlying conditions causing jaundice can also lead to their own complications.
Three main types of jaundice include:
Jaundice is a common health issue in newborn children.
The Centers for Disease Control and Prevention (CDC) note that approximately 60% of newborns develop jaundice, and signs appear within 48 hours of birth. A doctor or nurse should examine the baby when they are between 3–5 days old. This is because the bilirubin levels are usually at their highest during this time.
Red blood cells in the body of an infant are frequently broken down and replaced. This causes the production of more bilirubin. In addition, the livers of infants are less developed and are therefore less effective at filtering bilirubin from the body.
Symptoms will usually resolve without treatment in mild cases. However, infants with extremely high bilirubin levels will require treatment with either a blood transfusion or phototherapy.
In these cases, jaundice treatment in newborns is vital to help prevent kernicterus.
Causes of jaundice in newbornsAlthough jaundice in babies is common and often resolves without treatment, some underlying medical conditions can cause jaundice. These include:
Breastfeeding or chestfeeding can also increase the chance of jaundice in newborns. However, there is no need for a person to stop feeding the baby this way. In these cases, the symptoms of jaundice resolve in a few weeks.
According to a 2021 article, normal bilirubin levels are less than 1 milligram per deciliter (mg/dl).
A person has jaundice if these levels reach approximately 3 mg/dl.
A 2021 article notes that doctors may diagnose jaundice in infants if the bilirubin levels increase to 5 mg/dl per day or more than 0.2 mg/dl per hour.
These ranges may differ between laboratories. How far above the normal range a person's levels will help a doctor determine the best course of treatment.
Doctors will most likely start with the person's history and a physical exam to diagnose jaundice. They may later also order lab tests.
During an examination, they will pay close attention to the abdomen, liver, and skin.
The doctor may often include lab tests to help determine the underlying cause of jaundice. These include:
The doctor will also examine the structure of the liver if they suspect an obstruction. In these cases, they will use imaging tests, including MRI, CT, and ultrasound scans.
In addition, they may carry out an endoscopic retrograde cholangiopancreatography (ERCP). This is a procedure combining endoscopy and X-ray imaging.
The AAFP states that a healthcare professional may perform a liver biopsy. A liver biopsy can check for inflammation, cirrhosis, cancer, and fatty liver. This test involves inserting a needle into the liver to obtain a tissue sample. A healthcare professional will then examine the sample under the microscope.
Jaundice is the yellowing of the skin, mucous membranes, and whites of the eyes. It is a symptom of an underlying condition or health concern that involves the liver.
It occurs when the liver cannot keep up with the demand to process waste in the blood or when the liver becomes damaged. Several conditions can cause liver issues and result in jaundice.
Treatment for jaundice typically involves treating the underlying condition.
Read the article in Spanish.
Concerns Over Focus On Skin Colour In Newborn Checks
By Smitha MundasadHealth reporter
A review led by the NHS Race and Health Observatory has raised significant concerns about a focus on skin colour in routine health checks for newborns.
The Apgar score, determined by a series of quick assessments immediately after birth, traditionally includes checking whether the baby is "pink all over".
The report questions its relevance and accuracy for some babies belonging to ethnic minorities.
And it calls for an immediate update of maternity guidelines.
The wide-ranging review also looks at the diagnosis of newborn jaundice.
England's former chief midwife Prof Jacqueline Dunkley-Bent, who now co-chairs the NHS Race and Health Observatory group working on maternal and neonatal health, said: "This biased assessment is exemplified by terms like 'pink' being used to describe a well-perfused baby [with good blood supply], disregarding the diversity of skin colours within our population.
"Consequently, it raises concerns about the clinical accuracy of such assessments when applied to ethnically diverse populations."
Led by researchers from Sheffield Hallam University, the work reviews scientific literature and policies and involves interviews with 33 healthcare professionals and 24 parents.
First, it considers the Apgar score, devised in the 1950s.
Healthcare professionals check the baby's muscle tone, pulse, reflex response, breathing rate and appearance, giving each component a maximum score of two.
This often includes assessing the baby's appearance as:
The lower the overall score, the more likely the baby is to need urgent help.
The review found:
Experts say alternative systems for checking wellbeing should be evaluated.
The report also says there are concerns about the "subjective nature" of guidelines for assessing jaundice - a yellowing of the skin, whites of the eyes and gums caused by a build-up of a substance called bilirubin.
All babies are checked for jaundice, in the first few days of life - often midwives will do a visual check together with an assessment of how alert a baby is and how well it is feeding.
Though it is common and often resolves on its own, jaundice can cause very serious problems if not treated at the right time. A blood test can check levels.
Baby Jaxson was five days old in this picture, taken shortly before he was treatedLauren Clarke, a research practitioner in the East Midlands, had her son Jaxson in 2019.
She says by the time he was diagnosed with jaundice, when he was 6 days old, the levels were "very high and needed urgent treatment" but believes it should have been picked up and treated earlier.
Lauren said she noticed Jackson's eyes and skin looked yellow in his first few days but when she approached staff about it they told her to "keep an eye", with no further advice.
A midwife and two maternity support workers checked her baby visually after she went home but Lauren did not feel listened to.
It was only when she was admitted for treatment for a separate infection that staff on the ward did a blood test on Jaxson.
Lauren says when they got the results a junior doctor "took him immediately out of her arms" and gave him rapid light treatment.
Lauren told the BBC: "It was so hard when he was being treated with light therapy. I couldn't feed him and he was crying so much."
She added: "I think if he had not been mixed-race the jaundice would have been picked up sooner."
The hospital held a review and said concerns about jaundice should have been escalated.
The review says the baby's skin tone "may have made it more difficult to determine if the jaundice was getting worse."
Recommendations included better training for staff and making more use of handheld meters to measure jaundice levels.
The NHS Race and Health Observatory review found:
The review says there is a need for more consistent training for healthcare staff and parents on how to spot jaundice in babies belonging to ethnic minorities and recommends establishing a national image database.
Prof Dunkley-Bent and Dr Daghni Rajasingam, who co-chair the NHS Race and Health Observatory group working on maternal and neonatal health, said the review represented an urgent call to action.
"There is a pressing need for more objective outcome measures to mitigate the impact of racial bias when employing these assessments," they said.
"By rectifying these anomalies that are present in our current practices, we can strive towards a more equitable healthcare system that upholds the health and wellbeing of all newborns, irrespective of their ethnic background."
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Scientists Finally Know Why Pee Is Yellow
Paying attention to the color of your urine is one way to gauge if you're dehydrated. But have you ever stopped to wonder why pee is yellow in the first place?
For the first time, researchers have identified the enzyme responsible for urine's golden hue, in a new study published on January 3 in Nature Microbiology.
The discovery of this enzyme, called bilirubin reductase, finally solves the mystery behind why urine is yellow, says lead author Brantley Hall, PhD, assistant professor in the department of cell biology and molecular genetics at the University of Maryland in College Park.
The study results may do more than answer an age-old question. "Although more research is needed, this finding could lead to improved treatments for jaundice and inflammatory bowel disease," says Dr. Hall.
Research Into Jaundice Leads to DiscoveryHall and his team didn't actually set out to find out why urine is yellow. "Our lab studies gut microbes; we're interested in understanding the functions these microbes perform and how that relates to human health," Hall says.
In this study, investigators were studying how the gut microbiome — the trillions of microorganisms that populate our digestive tracts — might be related to jaundice in babies.
Jaundice is the yellow color seen on the skin of many newborns, caused by a buildup in the infant's blood of the yellow compound bilirubin. This happens because babies' livers aren't developed enough to get rid of the bilirubin.
Bilirubin Reductase Is the Enzyme That Causes Pee to Be YellowFor over a century, scientists have known that the body turns bilirubin in the blood into molecules in urine called urobilin, which impart a yellow color. But they didn't know which enzyme or collection of enzymes in the gut was responsible for this transformation.
Hall and his team discovered that gut microbes encode (make) bilirubin reductase, which then converts bilirubin into a colorless byproduct called urobilinogen. "Urobilinogen then spontaneously degrades [breaks down] into urobilin, which is responsible for the yellow color," Hall says.
Bilirubin Often Absent in Babies With Jaundice and Some People With IBDThe researchers hope that this finding could have important health implications. Although bilirubin reductase is present in almost all healthy adults, the scientists found that it's often missing from newborns.
"This absence may contribute to infant jaundice and the formation of pigmented gallstones," says Hall. If this hypothesis is confirmed, one approach to treating infant jaundice might be to add back the bacteria through a probiotic strategy, he says.
The enzyme is often lacking or missing in people with inflammatory bowel diseases such as Crohn's disease or ulcerative colitis, according to researchers. "The absence of bilirubin microbes may also contribute to the formation of gallstones, which has been observed in some people with inflammatory bowel disease," says Hall.
More research is needed to confirm these associations before any conclusions can be made, but the findings highlight yet another reason why our gut microbiome is so vital to human health, he adds.
It's Unlikely That People Who Are Dehydrated Produce More BilirubinThe color of urine is often used to gauge hydration levels, with darker yellow signaling potential dehydration. How does bilirubin fit in with that?
"People ask me if there is more bilirubin produced when you're dehydrated, and we don't think that's the answer. We think there's basically a constant amount of bilirubin produced by gut microbes, and the color that you see is a factor of hydration," says Hall.
What Color Yellow Should Your Urine Be?It's normal for the color of urine to vary from day to day, but it should stay within a certain range of yellow, according to the Cleveland Clinic. Pee that is pale straw or amber is ideal and signals that you're properly hydrated, according to experts.
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