1. Definition
Icterus, also called jaundice, is characterised by a yellowing of the skin and the whites of the eyes caused by an accumulation of bile pigment (bilirubin) in the blood, it can be a symptom of gallstones or liver infection or anaemia. There is an impressive number of different kinds of icterus: the catarrhal jaundice, chronic idiopathic or also haemolytic are just a part of this large amount of varieties.
The pathology we are interested in, is called jaundice of the newborn. This is the jaundice we can see in the first days or even first hours of a baby's life.
2. Physiology
At birth, all babies have a excess of red blood cells that are metabolised in the course of the first two weeks, into a pigment called bilirubin . In a large number of cases the icterus heals without any treatment.
In the case of a rhesus or ABO incompatibility, the destruction of the red blood cells is at an elevated level and the bilirubin in the blood can reach alarming levels.
Although benign or even normal in some cases, icterus can always revert to a severe case.
3. Types of Icterus and their dangers
Their are 4 varieties of newborn icterus :
The physiologic icterus occurs in practically every premature baby, and in every second term baby. The child needs to be examined by a paediatrician right after birth and just before discharge. When a diagnose of a physiologic icterus is made, the paediatrician will probably not start any treatment.
The retention icterus will only be mentioned for your information.
The third jaundice is called severe jaundice or severe icterus of the newborn. It's a result of the incompatibility we discussed in 1.2. Like its name indicates this is a severe disease which could endanger the baby's life. The baby will have to be admitted to a neonatal service.
The most dangerous icterus is the kernicterus. Due to the incompatibility, the haemolysis start already intrauterine. The excess bilirubin settles down in all tissues and specifically in the grey matter of the brains (hence its name). This disease often ends in a tragic way. In case the baby survives there will be severe neurological after-effects (cerebral paralysis).
4. Treatment
Exchange transfusion permits the immediate treatment of dangerous levels of bilirubin. This impressive operation consists of replacing the entire contaminated blood with donor blood. Doctors generally do not like resorting to this traumatising and painful technique because of the contamination risk for Aids, Kreutsfeld Jacob or other diseases or viruses.
No medicinal treatment exists for the treatment of severe icterus. Doctors try to prevent transfusion with the help of phototherapy.
