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Newborn Jaundice by Julie Rackliffe Lucey, MS

Definition

Jaundice is a yellow coloring in your baby’s skin and sometimes the whites of the eyes. Newborn jaundice 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

This condition can be treated. Contact your doctor if you think your baby may have jaundice.

Causes

The yellow coloring is caused by bilirubin. Bilirubin is a waste product. It is created when red blood cells are broken down. Bilirubin normally passes out of the body through feces or urine. Jaundice occurs when there is an abnormal buildup of bilirubin. Different types of jaundice have different reasons for the abnormal buildup of bilirubin:

Physiologic jaundice
- May be caused by the breakdown of fetal red blood cells.
- The baby’s body does not get rid of bilirubin very efficiently in the first days of life.
Breastfeeding jaundice
- Occurs in about 13% of breastfed babies.
- This type of jaundice is caused by dehydration and poor calorie intake. It may happen in babies that are not taking in enough breast milk.
Breast milk jaundice
- Occurs in only 2% of babies.
- It may be caused by a substance in breast milk that blocks the elimination of bilirubin.
Hemolysis
- Caused by massive breakdown of red blood cells.
- May be caused by mismatched blood types in mom and baby such as Rh disease .
- This type of jaundice will occur within the first 24 hours of life. It occurs before the baby leaves the hospital and can be harmful.
Inadequate liver function
- The liver may be impaired by an infection or liver disease.
- This type of jaundice usually happens before the baby leaves the hospital.

Risk Factors

The following factors increase your baby’s chances of developing newborn jaundice:

Prematurity—babies born before 36 weeks of pregnancy
Brother or sister treated for jaundice
Baby has a different blood type than mother, resulting in hemolysis
East Asian, Mediterranean, or Native American descent
Poor feeding with breast or bottle
Large bruises or a condition called cephalhematoma (bleeding under the scalp related to labor and delivery)
High bilirubin levels or signs of jaundice in the first 24 hours of life (before leaving the hospital)
Certain liver enzyme deficiencies
Infection

Symptoms

The main symptom of jaundice is yellow skin color. The color usually starts in the face. The yellow color may then spread down to the stomach and legs. Certain environments may make your baby appear yellow. To look for yellow skin, place your baby near a window or in a room with fluorescent light. If you are still unsure, press gently on the baby’s forehead or chest. Watch as the color reappears.

If your baby has yellow skin do not assume it is due to newborn jaundice. These symptoms may be caused by other health conditions.

When to Call the Doctor

Call your baby's doctor if you suspect your baby has jaundice.

If your baby has been diagnosed with jaundice, call your doctor if:

Yellow color gets deeper
Yellow color spreads to other parts of the body or the eyes
Jaundice lasts for more than three weeks.

Very high levels of bilirubin in your baby’s blood can be dangerous. It can lead to a very rare form of brain damage called kernicterus. It is important to see a doctor if your baby has signs of this condition. 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

Diagnosis

The American Association of Pediatricians recommends that all babies are assessed for jaundice before they leave the hospital. Your baby will be checked again at 3-5 days of age. If your doctor suspects jaundice, he will ask about your baby’s symptoms and medical history. A physical exam will be done.

Tests may include the following:

Examination of baby’s skin
Transcutaneous bilirubin (TcB)—a light is passed through the baby's skin to screen for high bilirubin levels
Blood test—to check level of bilirubin in blood, may be done if TcB shows a risk for high bilirubin levels

Treatment

Most babies with jaundice will not need treatment. Jaundice in formula-fed infants will usually clear up in two weeks. In breastfed babies, jaundice usually clears up in 2-3 weeks.

If your child does need treatment, talk with the doctor about the best treatment plan. Treatment options include:

Change in Feedings

Increased breastfeeding can help clear bilirubin from your baby's body. Your doctor may ask you to aim for 8-12 feeding per 24-hour period. Do not let your baby sleep for more than four hours without feeding during this time period. If you are having any problems breastfeeding, ask your doctor or lactation specialist for help.

Babies that are formula-fed will need to get extra formula. Ask the doctor for guidelines as to how much formula you should provide. You may need to give your baby 1-2 ounces (30-60 milliliters) of formula every 2-3 hours.

For most jaundice, extra breastfeeding is helpful. However, breast milk jaundice is caused by the breast milk. Your doctor may recommend stopping breastfeeding for a couple days. This will let the bilirubin decrease. Once the jaundice has cleared it is safe to resume breastfeeding.

Phototherapy

Phototherapy is the use of special lights. The lights helps alter the bilirubin in the blood. The bilirubin can then easily pass in the urine or through the gastrointestinal tract.

Your baby will be placed naked, or wearing only a small diaper, under special blue or white lights. A shield will help to protect your baby's eyes. Phototherapy may be done at home or in the hospital.

These light are specially designed to treat the bilirubin without harming your baby's skin. Putting your baby in the direct sunlight is NOT recommended. Direct sunlight on a naked baby can cause a dangerous sunburn.

Exchange Transfusion

In the most severe cases of jaundice, your doctor may recommend a blood transfusion. A transfusion will replace your baby’s blood with new blood. The excess bilirubin will be removed with the blood.

If your newborn is diagnosed with jaundice, follow your doctor's instructions .

Prevention

There is no known way to prevent newborn jaundice.

RESOURCES:

American Academy of Pediatrics http://www.healthychildren.org/
The March of Dimes http://www.marchofdimes.com/

CANADIAN RESOURCES:

Health Canada http://www.hc-sc.gc.ca/
Maternal and Infant Health Public Health Agency of Canada http://www.phac-aspc.gc.ca/

References:

Clinical practice guidelines: management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation. American Academy of Pediatrics website. Available at: http://aappolicy.aappublications.org/cgi/content/full/pediatrics;114/1/297 . Published July 2004. Accessed July 23, 2012.
Jaundice. Family Doctor.org website. Available at: http://familydoctor.org/online/famdocen/home/children/parents/common/common/756.html . Updated February 2010. Accessed July 23, 2012.
Jaundice in healthy newborns. Kids Health website. Available at: http://kidshealth.org/parent/pregnancy_center/newborn_care/jaundice.html . Updated June 2008. Accessed July 23, 2012.
Merck Manual. Hyperbilirubinemia. The Merck Manual of Diagnosis and Therapy website. Available at: http://www.merck.com/mmhe/sec23/ch264/ch264p.html . Updated February 2009. Accessed July 23, 2012.
Neonatal obstructive jaundice. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Updated February 2012. Accessed July 23, 2012.

Last reviewed September 2012 by Michael Woods

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