| What is jaundice in newborns? |
In the first few days of life, more than half of all full-term babies and 80 percent of premature infants who are otherwise healthy develop jaundice, a yellowish discoloration of the skin and eyes. Although some babies are jaundiced at birth, most develop the condition during the second or third day of life. That's why you may not notice it until after your baby is home.
Jaundice itself isn't a disease. In most cases it occurs because your baby's liver isn't mature enough to metabolize a molecule called bilirubin, which normally forms when the body recycles old or damaged red blood cells.
Jaundice usually isn't a cause for alarm and doesn't cause discomfort for your baby. It usually will disappear in 1 to 2 weeks. It should be monitored closely by your doctor, however. If necessary, a treatment using special ultraviolet lights can help keep your baby's blood level of bilirubin from becoming too high.
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| Signs and symptoms |
Signs and symptoms of jaundice in newborns may include:
- Yellowing of the skin
- Yellowing of the eyes
- Lethargy, in some cases
Jaundice commonly lasts for a week to 10 days in full-term newborns. If your baby is premature or if you breast-feed your baby, jaundice may last longer.
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| Causes |
A number of conditions can cause jaundice. If jaundice is present at birth or appears within 24 hours, it may be the result of several problems, including severe bruising, an infection in the baby's blood (sepsis), or an incompatibility between your blood and your baby's. Jaundice that develops in or lasts past the second week of life may be due to a liver malfunction, a severe infection, an enzyme deficiency or an abnormality of your baby's red blood cells. But in most cases, jaundice appears in the second or third day of life because your baby's liver can't process bilirubin fast enough. This is known as physiologic jaundice.
Babies are born with a generous supply of red blood cells, which help transport oxygen. Over time these red blood cells break down, and as they do bilirubin is formed. Normally bilirubin is transported to the liver where it's processed before being eliminated from the body. But newborns initially have more bilirubin than their livers can handle. This excess bilirubin causes their skin, and sometimes the whites of their eyes, to turn yellow.
Jaundice occurs more often, and is sometimes more severe, in premature babies because their livers are even less mature than those of full-term babies.
| Risk factors |
Boy babies tend to be at higher risk of jaundice than girls. Asian and American Indian infants also are more likely to have jaundice. Other factors that may put your newborn at risk of jaundice include:
- Prematurity. Because your premature baby's liver may not be able to process bilirubin as
quickly, he or she is at higher risk of jaundice. Your preemie may also feed less at first and have
fewer bowel movements, which means less bilirubin is likely to be eliminated in your baby's stool.
- Bruising during birth. Sometimes babies are bruised during birth. If your newborn has a
bruise, he or she may have a higher level of bilirubin from the breakdown of more red blood cells.
- Blood type. If your blood type is different from your baby's, your baby may have received
antibodies through the placenta that cause his or her blood cells to break down more quickly. Blood
groups are determined according to whether you have certain protein molecules on the surface of your
blood cells. The rhesus (Rh) factor is one of these blood groups. If you have the Rh factor in your
blood cells, you're considered Rh positive. If you don't, you're Rh negative. There is nothing
inherently wrong with being either Rh positive or Rh negative. But problems can arise when an
Rh-negative woman is pregnant with an Rh-positive baby. In Rh-negative women, injections of Rh (D)
immune globulin (RhoGAM) during the pregnancy and immediately following birth can minimize the
likelihood of problems.
- Breast-feeding. Breast-fed babies have a higher risk of jaundice, but for most newborns the
risk is slight and is far outweighed by the benefits of breast-feeding. In addition, if a mother's
milk is slow to let down, her baby may not gain weight as readily, which makes jaundice more
pronounced. Breast-feeding more than the usual 8 to 10 times a day might reduce the risk. This will
encourage your baby to have more bowel movements. Breast-milk-related jaundice normally appears 4 to 7
days after birth and may last for several weeks.
- Early discharge from the hospital. Because bilirubin levels tend to rise during the second and third days of life, babies who are released from the hospital less than 72 hours after birth are at increased risk of developing jaundice after they're home. Before early discharges were common, jaundice was usually recognized and treated in the hospital nursery.
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| When to seek medical advice |
During the first few days after your baby goes home following birth, be alert for the development of jaundice. Call or see your baby's doctor if your newborn develops jaundice or begins to look or act sick. In addition, check with your baby's doctor if your newborn's jaundice is severe (the skin is bright yellow), if it lasts longer than 1 or 2 weeks, if your baby isn't gaining weight, or if your baby develops any other symptoms that concern you.
If your baby was born at 36 to 38 weeks gestational age — several weeks early — be particularly alert for the development of jaundice or poor feeding. Babies born in this age range have a higher likelihood of needing medical treatment for jaundice following their discharge from the hospital. Arranging with your doctor to have the baby's weight checked within several days after going home makes it easy to monitor both weight gain and jaundice. Don't hesitate to ask about having your baby's weight checked: It's easy, quick to do and reassuring.
| Screening and diagnosis |
Your doctor will likely diagnose jaundice on the basis of your baby's appearance. He or she may also take a small sample of your baby's blood to measure the bilirubin level. Your baby may have additional blood tests if the jaundice requires treatment or if you and your baby have different blood types.
| Complications |
When bilirubin reaches extremely high levels, especially in newborns ill enough to require treatment in a newborn intensive care unit, it can lead to a rare, but very serious, condition called kernicterus. This disorder causes damage to a newborn's brain. It may also cause deafness, severe developmental disabilities and an unusual form of cerebral palsy characterized by uncontrolled writhing movements, especially of a baby's limbs.
| Treatment |
Mild jaundice in newborns often disappears on its own within a week or two. But if your baby has moderate or severe jaundice, he or she may need to stay longer in the newborn nursery or be readmitted to the hospital. Treatments to lower the level of bilirubin in your baby's blood may include:
- Light therapy (phototherapy). Your baby may be placed under a special ultraviolet light or
wrapped in a fiber-optic blanket of light. The light changes the bilirubin into a form that can be
eliminated by your baby's kidneys. Newborns with jaundice typically receive phototherapy for several
days. Babies are no longer readmitted to the hospital for phototherapy as often as they once were.
- Intravenous immune globulin (IVIG). If moderate to severe jaundice develops because of
blood group differences between mother and baby, an intravenous transfusion of antibodies may decrease
the jaundice and lessen the need for exchange blood transfusion.
- Exchange blood transfusion. For extremely rare severe jaundice that doesn't respond to other treatments, a baby may need an exchange transfusion of blood. This involves repeatedly withdrawing small amounts of blood, "diluting out" the bilirubin and maternal antibodies, and then transferring the blood back into the baby. A doctor would move the baby to a newborn intensive care unit for this procedure.
| Self-care |
When jaundice isn't severe, the following may help lower your newborn's bilirubin level:
- More frequent feedings. Feeding more frequently will provide your baby with more calories
and cause more bowel movements, which increase the amount of bilirubin passed in your baby's stool.
- Using formula milk. Temporarily supplementing breast milk with formula or changing to formula, even for only 1 or 2 days, may quickly lower your baby's bilirubin level. You can use a breast pump to express your milk until you start breast-feeding again. Some doctors may hesitate to suggest this approach, however, because they don't want to interrupt your efforts to breast-feed your baby.