Jaundice in Newborns (Hyperbilirubinemia)
What is jaundice in newborns?
Jaundice is a yellow tint to a newborn's skin and the white part of the eyes. It is a sign that there's too much bilirubin in the baby's blood. The word for having too much bilirubin in the blood is hyperbilirubinemia (say "hy-per-bil-ih-roo-bih-NEE-mee-uh").
Jaundice usually appears in the first 5 days of life. Many babies have left the hospital by the time jaundice starts. So your doctor may want to do a follow-up exam when your baby is 3 to 5 days old.
Most babies have mild jaundice. It usually gets better or goes away on its own within a week or two without causing problems. But jaundice should be taken seriously. In rare cases, if the bilirubin level stays high and isn't treated, it can cause brain damage called kernicterus. This can lead to serious lifelong problems.
What causes jaundice in newborns?
Jaundice occurs because your baby's body has more bilirubin than it can get rid of. Bilirubin is a yellow substance that's made when the body breaks down old red blood cells. It leaves the body through urine and stool. When you're pregnant, your body removes bilirubin from your baby through the placenta. After birth, your baby's body must get rid of the bilirubin on its own.
In most cases, babies have what's called physiologic jaundice. It occurs because their organs aren't yet able to get rid of excess bilirubin very well. This type of jaundice usually appears about 24 hours after birth. It gets worse until the third or fourth day, and then it goes away in about a week.
In rare cases, jaundice may be caused by other things, such as an infection, a problem with the baby's digestive system, or a problem with the mom's and baby's blood types (Rh incompatibility). Your baby may have one of these problems if jaundice appears less than a day after birth.
What are the symptoms?
If a newborn has jaundice, his or her skin and the white part of the eyes will look yellow. The yellow color shows up first in the baby's face and chest, usually 1 to 5 days after birth.
A baby whose bilirubin level is high may:
- Get more yellow.
- Be sluggish and not suck well.
- Be cranky or jittery.
- Arch his or her back.
- Have a high-pitched cry.
A high bilirubin level can be dangerous. Make sure to call a doctor right away if your baby has any of these symptoms.
How is jaundice in newborns diagnosed?
Your baby's doctor will do a physical exam and ask you questions about your health and your baby's health. For example, the doctor might ask if you and your baby have different blood types.
The doctor may place a device against your baby's skin to check your baby's bilirubin level. A blood test for bilirubin may be done to find out if your baby needs treatment.
More tests may be needed if the doctor thinks that a health problem is causing too much bilirubin in the blood.
How is it treated?
Your baby will need treatment if the bilirubin level is above the normal range for newborns. He or she will be put under a special light to treat the jaundice. This is called phototherapy. The skin absorbs the light, which changes the bilirubin so that the body can more easily get rid of it. The treatment is usually done in a hospital. But babies sometimes are treated at home.
Don't try to treat jaundice by placing your baby in the sun or near a window. Special lights and controlled surroundings are always needed to treat jaundice safely.
If a health problem caused the jaundice, your baby may need other treatment. For example, a baby with severe jaundice caused by Rh incompatibility may need a blood transfusion.
How can you help your baby?
If your baby has jaundice, you have an important role to play.
- Look closely at your baby's skin 2 times a day to make sure that the color is returning to normal. If your baby has dark skin, look at the white part of the eyes.
- Take your baby for any follow-up testing your doctor recommends.
- Call the doctor if the yellow color gets brighter after your baby is 3 days old.
The best thing you can do to reduce jaundice is to make sure that your baby gets enough to eat. That will help your baby's body get rid of the extra bilirubin.
- If you are breastfeeding, feed your baby about 8 to 12 times every 24 hours.
- If you are feeding your baby from a bottle, stay on your schedule (usually about 6 to 10 feedings every 24 hours).
If you aren't sure that your baby is getting enough milk, ask your doctor, a nurse, or a lactation consultant for help.
Other Works Consulted
- American Academy of Pediatrics (2004). Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation. Pediatrics, 114(1): 297–316. [Erratum in Pediatrics, 114(4): 1138.]
- Kamath BD, et al. (2011). Jaundice. In SL Gardner et al., eds., Merenstein and Gardner's Handbook of Neonatal Intensive Care, 7th ed., pp. 531–552. St. Louis: Mosby Elsevier.
- Kissoon N (2008). Jaundice. In JM Baren et al., eds., Pediatric Emergency Medicine, pp. 340–344. Philadelphia: Saunders Elsevier.
- Lee HC, Madan A (2011). Hematologic abnormalities and jaundice. In CD Rudolph et al., eds., Rudolph's Pediatrics, 22nd ed., pp. 226–233. New York: McGraw-Hill.
- Maheshwari A, Carlo WA (2011). Digestive system disorders. In RM Kliegman et al., eds., Nelson Textbook of Pediatrics, 19th ed., pp. 600–612. Philadelphia: Saunders.
- Woodgate P, Jardine LA (2015). Neonatal jaundice: Phototherapy. BMJ Clinical Evidence. http://clinicalevidence.bmj.com/x/systematic-review/0319/overview.html. Accessed April 1, 2016.