Over half of all newborns develop some amount of jaundice, a yellow coloring in their skin, during the first week. This is usually a temporary condition, but may be a more serious sign of another illness. Jaundice is caused by the breakdown of red blood cells. As the old cells are broken down, hemoglobin is changed into bilirubin and removed by the liver. The build-up of bilirubin in the blood is called hyperbilirubinemia. Because bilirubin has a pigment, or coloring, it causes a yellowing of the baby's skin and tissues. As liver function matures, the jaundice goes away. A premature infant is more likely to develop jaundice. The yellow tint to the skin can often be seen by gently pressing on the baby's forehead or chest and watching the color return.
There are several types of jaundice:
- physiologic jaundice
Physiologic jaundice occurs as a "normal" response to the baby's limited ability to excrete bilirubin in the first days of life.
- breast milk jaundice
About 2 percent of breastfed babies develop jaundice after the first week. Some develop breast milk jaundice in the first week due to low calorie intake or dehydration.
- jaundice from hemolysis
Jaundice may occur with the breakdown of red blood cells due to hemolytic disease of the newborn (Rh disease), having too many red blood cells, or bleeding.
- jaundice related to inadequate liver function
Jaundice may be related to inadequate liver function due to infection or other factors.
Although low levels of bilirubin are not usually a concern, large amounts can circulate to tissues in the brain and may cause seizures and brain damage. This is a condition called kernicterus.
The following are the most common symptoms of jaundice. However, each baby may experience symptoms differently. Symptoms may include:
- yellow coloring of the baby's skin - usually beginning on the face and moving down the body
- poor feeding or lethargy
Symptoms of jaundice may resemble other conditions or medical problems. Always consult your baby's physician for a diagnosis.
The timing of the appearance of jaundice helps with the diagnosis. Jaundice appearing in the first 24 hours is quite serious and usually requires immediate treatment. When jaundice appears on the second or third day, it is usually "physiologic." However, it can be a more serious type of jaundice. When jaundice appears on the third day to the first week, it may be due to an infection. Later appearance of jaundice, in the second week, is often related to breast milk feedings, but may have other causes.
Laboratory testing for hyperbilirubinemia may include:
- direct and indirect bilirubin levels - These levels reflect whether the bilirubin is bound with other substances by the liver so that it can be excreted (direct), or is circulating in the blood circulation (indirect).
- red blood cell counts
- blood type and testing for Rh incompatibility (Coomb's test)
Specific treatment for jaundice will be determined by your baby's physician based on:
- your baby's gestational age, overall health, and medical history
- extent of the disease
- your baby's tolerance for specific medications, procedures, or therapies
- expectations for the course of the disease
- your opinion or preference
Treatment depends on many factors, including the cause of the jaundice and the level of bilirubin. The goal is to keep the level of bilirubin from increasing to dangerous levels. Treatment may include:
Because bilirubin absorbs light, jaundice and increased bilirubin levels usually decrease when the baby is exposed to special blue spectrum lights. Phototherapy may take several hours to begin working and it is used throughout the day and night. The baby's position is changed to allow all of the skin to be exposed to the light. The baby's eyes must be protected and the temperature monitored during phototherapy. Blood levels of bilirubin are checked to monitor if the phototherapy is working.
- use of a fiberoptic blanket
Another form of phototherapy is a fiberoptic blanket placed under the baby. This may be used alone or in combination with regular phototherapy.
- exchange transfusion
Exchange transfusion may be used to replace the baby's damaged blood with fresh blood. This helps increase the red blood cell count and lower the levels of bilirubin. An exchange transfusion is done by alternating giving and withdrawing blood in small amounts through a vein or artery. Exchange transfusions may need to be repeated if the bilirubin levels remain high.
- discontinued breastfeeding
Treatment of breast milk jaundice often requires stopping the breastfeeding for one to two days. Giving the baby formula often helps lower the bilirubin levels. Breastfeeding can then be resumed.
- treatment of underlying conditions
Treating any underlying cause of hyperbilirubinemia, such as infection.
While jaundice cannot be totally prevented, early recognition and treatment are important in preventing bilirubin levels from rising to dangerous levels. If your baby's color is turning more yellow, promptly call your baby's physician.
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