Pediatric - Jaundiced Newborn
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Does this describe your child's symptoms?
- The skin and whites of the eyes have turned yellow
Types of Jaundice
Physiological jaundice (50% of newborns)
- Onset 2 to 3 days of age
- Peaks day 4 to 5, then improves
- Disappears 1 to 2 weeks of age
Breastfeeding jaundice (5 to 10% of newborns)
- Due to inadequate intake of breastmilk
- Pattern similar to physiological type
Breastmilk jaundice (1% of newborns)
- Due to substance in breastmilk which blocks destruction of bilirubin
- Onset 4 to 7 days of age
- Lasts 3 to 10 weeks
- Not harmful
Rh and ABO blood group incompatibility
- Onset during first 24 hours of life
- Can reach harmful levels
|Call 911 Now (your child may need an ambulance) If|
- Unresponsive or difficult to awaken
- Not moving or very weak
|Call Your Doctor Now (night or day) If|
- Newborn starts to look or act sick (e.g., decrease in activity or ability to suck)
- Signs of dehydration (no urine in 8 hours, very dry mouth, sunken soft spot)
- Fever above 100.4° F (38.0° C) rectally (Caution: Do NOT give your baby any fever medicine before being seen)
- Low temperature below 96.8° F (36.0° C) rectally that doesn't respond to warming
- Jaundice began during the first 24 hours of life
- Skin looks deep yellow or orange
- Jaundice has reached the legs
- You think your child needs to be seen
|Call Your Doctor Within 24 Hours (between 9 am and 4 pm) If|
- You are concerned your baby is not getting enough breastmilk
- Good-sized yellow, seedy stools are less than 3 per day (EXCEPTION: breastfed and before 5 days of life)
- Day 2-4 of life and no stool in over 24 hours and breastfed
- Wet diapers are less than 6 per day (EXCEPTION: 3 wet diapers/day can be normal before 5 days of life if breastfed)
- Discharged before 48 hours of life AND 4 or more days old AND hasn't been examined since discharge (Reason: AAP recommends re-check)
- High-risk baby for severe jaundice (premature baby of 35 weeks or earlier, ABO or Rh blood group problem, sibling needed bili-lights)
- You have other questions or concerns
|Call Your Doctor During Weekday Office Hours If|
- Color gets deeper after 7 days old
- Jaundice is not gone after 14 days of age
- Jaundice began or reappeared after 7 days of age
- Stools are white, pale yellow or gray
|Parent Care at Home If|
- Mild jaundice of newborn and you don't think your child needs to be seen
HOME CARE ADVICE FOR MILD JAUNDICE
And remember, contact your doctor if your child develops any of the "Call Your Doctor" symptoms.
- Bottlefed: If bottle fed, increase the frequency of feedings. Try for an interval of every 2 to 3 hours during the day.
- Breastfed: If breastfed, increase the frequency of feedings. Nurse your baby every 1½ to 2½ hours during the day. Don't let your baby sleep more than 4 hours at night without a feeding.
- Increase Stools:
- If your baby is 5 days or older AND has less than 3 stools/day, carefully insert a lubricated thermometer ½ inch (12 mm) into the anus and gently move it from side to side a few times to stimulate a stool.
- Reason: increased stools carry more bilirubin out of the body
- Do this once or twice per day until jaundice improves or stool frequency becomes normal.
- Expected Course: Physiological jaundice peaks on day 4 or 5 and then gradually disappears over 1-2 weeks.
- Judging Jaundice:
- View your baby unclothed in natural light near a window.
- Press on the yellow skin on the chest with a finger to remove the normal skin tone.
- Then assess the jaundice color before the pink color returns.
- Call Your Doctor If:
- Jaundice not gone by day 14
- Your baby is not getting enough milk (needs a weight check)
- Your baby starts to act sick
- Your child becomes worse
Disclaimer: This information is not intended be a substitute for professional medical advice. It is provided for educational purposes only. You assume full responsibility for how you choose to use this information.
Author and Senior Reviewer: Barton D. Schmitt, M.D.
Last Reviewed: 1/19/2009
Last Revised: 6/24/2008
Content Set: Pediatric HouseCalls Online
Copyright 1994-2009 Barton D. Schmitt, M.D.