Risk factors and common complications associated with jaundice

Babies

Risk factors and potential complications affecting infants are:

• Premature birth: A baby that is born prematurely (before 38 weeks) may not be able metabolise bilirubin sufficiently and the amount produced in the system may be overwhelming for their little liver. A prem baby may also feed less and have fewer bowel movements. This means that little or no bilirubin is being excreted from the body.
• Blood type mismatch: A new-born who has a different blood type to his or her mother may react to antibodies received through the placenta. The baby’s RBCs will break down a little quicker and result in jaundice.
• Severe bruising during birth: A significantly difficult delivery can cause a little bruising for a new-born. This will typically result in the production of more bilirubin in the body and the early breakdown of more RBCs (before their usual lifespan is reached).
• Breastfeeding problems: Dehydration and low calorie intake can lead to the development of jaundice. A nursing mother should not stop breastfeeding even when a baby is diagnosed as having jaundice. A baby may not need treatment but still requires enough to eat and must remain sufficiently hydrated as well.
• Acute bilirubin encephalopathy: Severe cases of jaundice can occur when bilirubin becomes toxic to the cells of the brain. If this happens, immediate medical treatment is required. Signs of severe jaundice include a high-pitched cry (scream), poor feeding, a fever, vomiting, difficulty in waking the baby and a backward arching of the neck and body.
• Kernicterus: If acute bilirubin encephalopathy worsens, permanent damage is caused to the brain. A baby will experience hearing loss, involuntary or uncontrolled movements (athetoid cerebral palsy), problems with the development of tooth enamel, and also develop a permanent upward gaze.

Adults

Adults are at risk of developing jaundice due to an underlying cause (as mentioned in the causes section). Other causes can include hereditary conditions (whereby RBCs are destroyed and excreted from the body before their normal lifespan is over) such as thalassemia or hereditary spherocytosis, or types of skin diseases such as pyoderma gangrenosum (a condition that causes painful skin ulcers) and inflammation of the joints (polyarthralgias).

Some individuals will make a full recovery, while others may experience long-term complications related to the underlying cause. Life-threatening complications include conditions such as anaemia, electrolyte abnormalities, internal bleeding, kidney failure, hepatic encephalopathy (brain function loss due to liver damage that prevents toxin removal from the blood), and in worst case scenarios, death.

Many of the complications which can occur in adults with jaundice relate to side-effects from medication used to treat the various underlying causes. Common side-effects include:

• Digestive issues – gas, an upset stomach, diarrhoea, constipation, bloating
• Stomach pain
• Vomiting