Jaundice in Newborns
Author: Dr. Anna Kaplan
Jaundice is the term for a yellow tint of the skin caused by bilirubin. Bilirubin is a pigment that comes from red blood cells. Red blood cells are recycled about every 90 days. During the recycling, bilirubin is released. In healthy children and adults, bilirubin goes to the liver where it is broken down and eventually removed from the body. Adults with liver disease can become jaundiced.
A newborn baby's liver cannot handle bilirubin. Before birth, the baby's mother's liver metabolizes the bilirubin. After birth, until the baby's liver matures, it stays in the blood and gets into body tissues. In the skin, it causes jaundice. Even the whites of the eyes can turn yellow. If the bilirubin rises too high and too quickly, it can be high enough to get into the brain. Bilirubin in the brain is called kernicterus, and it causes severe damage. Luckily, this is very rare.
All babies have some bilirubin elevation. About 60% of the time it is visible. Jaundice appears in the face first and progresses down the baby's body. You can see it better if you apply light pressure to the skin. You may then be able to see a yellow tint.
Doctors and nurses who take care of newborn babies watch for jaundice. Any newborn who appears to be jaundiced will have his or her bilirubin checked. Any jaundice in the first 24 hours is abnormal and will need evaluation. Any elevated bilirubin level that is too high for the baby's age or rising too quickly will need more evaluation.
The normal peak of bilirubin levels is when the baby is between 3 and 5 days of age. That is why you will be asked to bring your newborn in to be checked by a healthcare provider if he or she leaves the hospital less than 72 hours after birth. Most jaundice in newborns does not need treatment. The baby's liver matures and starts to break down bilirubin, and it goes away.
Jaundice may occur more often in breast-fed babies, but breast milk jaundice is not a reason to stop breast-feeding. Mothers are encouraged to breast feed their babies 8 to 12 times per 24 hours in the first days after birth. That helps give the baby enough calories and water and also helps make sure the mother will have a good supply of milk. Enough feeding helps lower the bilirubin.
Very high bilirubin levels need to be treated. The first treatment is called phototherapy. The baby is placed under special lights. This usually brings bilirubin levels down. This treatment can be done in most nurseries. Occasionally it can be done at home. Do not ever try and treat a baby with jaundice by putting him in direct sunlight. Sunlight is not safe for a baby's skin.
In the most severe cases, a baby with an extremely high level of bilirubin at risk of brain damage from kernicterus will need an exchange transfusion. This procedure should only be done in a neonatal ICU with very experienced doctors and nurses.
There are babies more likely to have jaundice. Babies born early are more likely to have jaundice, as are babies with certain inherited diseases. Newborns that are sick with other illnesses are more likely to have jaundice. So are babies who have bruising around the head from the birth process.
If you and your baby do not have the same blood type, that can increase the risk that the baby will have higher bilirubin levels. This happens most often with an Rh negative mother and Rh positive baby. Your doctor will know your blood type. If you are Rh negative, the baby's blood type will be checked and he or she will be watched closely for jaundice. This is not usually a problem during your first pregnancy.
Many of the problems just mentioned will be known at the time the baby is born. If you have a family history of babies with jaundice or you have already had a baby with jaundice, be sure and tell your doctor.
If you are breast-feeding, your baby's jaundice might last two or three weeks. If you are bottle-feeding, the jaundice may disappear in about two weeks. You need to have your baby checked according to the instructions you get when he or she leaves the hospital. If you are having trouble breast-feeding, or the jaundice seems to be getting worse, call your baby's doctor.
