Jaundice, a common condition in newborns, refers to the yellow color of the skin and whites of the eyes that happens when there is too much bilirubin in the baby’s blood.
Bilirubin is produced by the normal breakdown of red blood cells. Normally, bilirubin passes through the liver, which releases it into the intestines as bile (a liquid that helps with digestion).
Jaundice happens when bilirubin builds up faster than a newborn's liver can break it down and pass it from the body. Here are some reasons why this occurs:
- Newborns make more bilirubin than adults since they have more turnover of red blood cells
- A newborn’s still-developing liver might not be able to remove enough bilirubin from the blood
- A baby's intestines absorb bilirubin that would normally leave the body in the stool
In 2005, our healthcare system, HCA Healthcare, became the first healthcare company to mandate a simple, $1 blood test to screen newborns for elevated levels of bilirubin. If left untreated, severe jaundice can lead to kernicterus, a serious brain-damaging condition that can cause cerebral palsy, hearing loss, vision impairments and dental enamel loss.
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Types of jaundice
The most common types of jaundice are:
Physiological (normal) jaundice: Most newborns have this mild jaundice because their liver is still maturing. It often appears when a baby is 2 to 4 days old and disappears by 1 to 2 weeks of age.
Jaundice of prematurity: This is common in premature babies since their bodies are less prepared to excrete bilirubin effectively. To avoid complications, they'll be treated even when their bilirubin levels are lower than those of full-term babies with normal jaundice.
Breastfeeding jaundice: Jaundice can happen when breastfeeding babies don't get enough breast milk due to difficulty with breastfeeding or because the mother's milk isn't in yet. This is not caused by a problem with the breast milk itself, but by the baby not getting enough of it. If a baby has this type of jaundice, it's important to involve a lactation consultant.
Breast milk jaundice: In 1 to 2 percent of breastfed babies, jaundice is caused by substances in breast milk that can make the bilirubin level rise. These can prevent the excretion of bilirubin through the intestines. It starts after the first three to five days and slowly improves over three to 12 weeks.
Blood group incompatibility (Rh or ABO problems): If a mother and baby have different blood types, the mother's body might produce antibodies that destroy the infant's red blood cells. This creates a sudden buildup of bilirubin in the baby's blood. Incompatibility jaundice can begin as early as the first day of life. Rh problems once caused the most severe form of jaundice, but now can be prevented by giving the mother Rh immune-globulin injections.
Signs and symptoms
Jaundice usually appears around the second or third day of life. A jaundiced baby's skin usually will appear yellow first on the face, then the chest and stomach, and finally, the legs. Jaundice can also make the whites of a baby's eyes look yellow.
Most newborns go home from the hospital one to two days after birth, so it's important for their doctors to check them for jaundice one to two days later.
Parents should also watch their baby for jaundice. Jaundice can be hard to see, especially in babies with dark skin. If you're unsure, gently press the skin on your baby's nose or forehead – if jaundice is present, the skin will appear yellow when you lift your finger.
When to call the doctor
Call your doctor if you think your baby might have jaundice. It is difficult to tell how significant jaundice is just by looking at a baby, so any baby with yellow eyes or skin should be checked by a doctor.
Call your doctor immediately if:
- your baby has jaundice during the first 24 hours of life
- the jaundice is spreading or getting darker or more intense
- your baby has a fever over 100 °F (37.8 °C), rectally
- your baby starts to look or act sick
- your baby is not feeding well
- you feel your baby is sleepier than usual
Most cases of newborn jaundice don't require treatment. Mild or moderate jaundice will go away after one or two weeks.
More frequent feedings of breast milk or supplementing with formula to help infants pass the bilirubin in their stools might also be recommended. In some cases, the doctor may ask a mother to temporarily stop breastfeeding. If this happens, pump often to keep producing breast milk, then start nursing again once the jaundice has cleared.
For high levels of jaundice, phototherapy – treatment with a special light that helps rid the body of the bilirubin – may be used. If a baby has severe jaundice that hasn't responded to other treatments, a blood transfusion may be done.