Jaundice (hyperbilirubinemia) is a yellow coloring in your baby’s skin and sometimes in the whites of the eyes. It happens during the first weeks of life. There are many types of jaundice, including:
- Physiologic jaundice
- Breastfeeding jaundice
- Breast milk jaundice (human milk jaundice syndrome)
- Jaundice caused by hemolysis or increased bilirubin production
- Jaundice caused by inadequate liver function (due to inborn errors of metabolism, prematurity, or enzyme deficiencies)
Baby with Jaundice
The yellow coloring is caused by bilirubin, a waste product created by the body when it breaks down red blood cells in the normal course of metabolism. If you are unsure whether your baby’s skin is yellow with jaundice, look at the baby naked in natural or fluorescent light. Press down gently on the baby’s forehead or chest and watch as the color returns.
This condition can easily be treated; contact your doctor if you think your baby may have newborn jaundice.
Physiologic jaundice—usually has a peak bilirubin level less than or equal to 15.
- Is thought to result from increased bilirubin after breakdown of fetal red blood cells.
- The baby’s body does not get rid of bilirubin very efficiently in the first days of life, and the build-up of this substance causes a yellowing of the skin.
Breastfeeding jaundice—occurs in about 13% of breastfed babies.
- Occurs when the baby is not taking in enough breast milk, causing dehydration and poor calorie intake
Breast milk jaundice—occurs in only 2% of babies.
- A substance in breast milk that blocks the elimination of bilirubin may cause it.
- Stopping breastfeeding for a couple of days allows the bilirubin to decrease; it is then safe to resume breastfeeding.
- Caused by massive breakdown of red blood cells.
- Rh disease]]> and blood group incompatibility are two possible causes.
- This type of jaundice will occur within the first 24 hours of life, before the baby leaves the hospital, and can be harmful.
Inadequate liver function
- Can be caused by an infection or other condition that keeps the liver from operating properly.
- It usually happens before the baby leaves the hospital.
The following factors increase your baby’s chances of developing newborn jaundice. If your baby has any of these risk factors, tell your doctor:
- Premature babies born before 36 weeks of pregnancy
- Babies who had a brother or sister treated for jaundice
- Your baby has a different blood type than you, resulting in hemolysis
- Babies of East Asian, Mediterranean, or Native American descent
- Babies who are not feeding well, breast or bottle
- Babies with large bruises or a condition called cephalhematoma (bleeding under the scalp related to labor and delivery). Since many red blood cells are broken down when large bruises heal, more bilirubin than usual is traveling in the blood.
- Babies with high bilirubin levels or signs of jaundice in the first 24 hours of life (before leaving the hospital) will be watched carefully by the doctor even after they have left the hospital.
- Certain liver enzyme deficiencies
If your baby experiences any of these symptoms do not assume it is due to newborn jaundice. These symptoms may be caused by other, less serious health conditions. If your baby experiences any one of them, see your baby’s doctor.
- Yellow color on the skin, usually starting with the face, is the main symptom of jaundice. The yellow color may spread down to the stomach and legs.
Place your baby near a window without any clothes on, or in a room with fluorescent light, and look at his or her skin. If you are unsure, press gently on the baby’s forehead or chest and watch as the color reappears.
When to Call the Doctor
Call the doctor if your baby has already been diagnosed with jaundice and the color gets deeper, or if the yellow color spreads to other parts of the body or the eyes. Also call the doctor if your baby has already been diagnosed with jaundice and it persists for more than three weeks.
Call the doctor immediately if your baby:
- Is tired all the time or difficult to wake
- Sucks or nurses poorly
- Looks weak or floppy
- Arches his or her back or neck backwards
- Develops a high-pitched cry or fever
- Has convulsions or spasms
These are signs that the level of bilirubin in your baby’s blood is dangerously high. Too much bilirubin in your baby’s blood can lead to a very rare form of brain damage called kernicterus. There are effective treatments for kernicterus as long as the baby is seen by the doctor.
The American Association of Pediatricians recommends that all babies be assessed for jaundice before they leave the hospital. They are checked again at 3 to 5 days of age. Your baby’s doctor will ask about your baby’s symptoms and medical history, and perform a physical exam.
Tests may include the following:
- Examination of baby’s skin, including obtaining a transcutaneous bilirubin (TcB) level for screening
- Blood test to check level of bilirubin in blood. This will also be done if the TcB demonstrates that the baby is at risk for significant hyperbilirubinemia.
Most babies with jaundice will not require treatment. Talk with your baby’s doctor about the best treatment plan for your baby, if one is necessary. Treatment options include:
Baby is placed naked, or wearing only a small diaper, under special blue or white lights called bili-lights. The baby will have a shield to protect his or her eyes. The lights help the bilirubin in the blood to change so that it can easily be eliminated in the urine, and in bile through the gastrointestinal tract. Phototherapy can take place at home or in the hospital.
Putting your baby in the sunlight is NOT recommended. Exposure to direct sunlight on a naked baby can cause dangerous sunburn.
The doctor may suggest that you increase the number of feedings to increase the number of bowel movements. Bowel movements help to eliminate bilirubin. Your baby’s pediatrician may suggest feeding a breastfed-baby formula for a day or two to increase the amount of liquids the baby takes. You should pump during this time so that breast milk will be available for the baby after the treatment. Breast milk is the best food for your baby.
In the most severe cases of jaundice, the doctor may recommend replacing your baby’s blood with new blood.
If your newborn is diagnosed with jaundice, follow your doctor's instructions.
American Academy of Pediatrics
The March of Dimes
Alberta Children's Services
Behrman RE, Kliegman RM, Jenson HB. Nelson Textbook of Pediatrics . 17th Ed. Philadelphia PA: Saunders; 2004.
Hyperbilirubinemia. The Merck Manual of Diagnosis and Therapy website. Available at: http://www.merck.com/mmhe/sec23/ch264/ch264p.html . Accessed September 19, 2005.
Jaundice and your newborn. American Academy of Pediatrics website. Available at: http://www.aap.org/family/jaundicefaq.htm . Accessed September 19, 2005.
Maisels MJ. Neonatal jaundice. Pediatrics in Review . 2006; 27(12):443-453.
Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation. Subcommittee on Hyperbilirubinemia. Pediatrics . 2004;114(1):297-316.
RM Kleigman, RE Behrman, HB Jenson, BF Stanton. Nelson Textbook of Pediatrics . 18th Edition. Eds. Saunders Publishers, Philadelphia PA, 2007.
Newborn jaundice. Medline Medical Encyclopedia website. Available at: http://www.nlm.nih.gov/medlineplus/ency/article/001559.htm . Accessed September 19, 2005.
Last reviewed November 2008 by ]]>Kari Kassir, MD]]>
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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