Why Do Newborns Get Jaundice

What Is The Problem With Yellow

Jaundice in newborns is usually divided into two types:

Physiological jaundice: It usually resolves on its own after a short time.

Pathological jaundice: a sign of a specific disease. Children with this condition often develop symptoms such as convulsions, coma, etc.

Whether or not newborn jaundice is dangerous is a question many parents ask.

What Are The Signs And Symptoms Of Jaundice In Newborns

The main sign of jaundice is the yellowing of your babys skin. You can see it best in natural lighting, such as in front of a window. It usually appears in your babys face first. The whites of your babys eyes and under their tongue may look yellow. As the level of bilirubin increases, the yellowing may move to your babys chest, belly , arms and legs. Jaundice may be difficult to see if your baby has darker skin. But you should still be able to tell if your baby has jaundice by the color of their eyes and under their tongue.

Why Do Babies Have Such High Bilirubin Levels Compared To Older Children

The high bilirubin is caused by several differences between newborns and older children and adults:

• Healthy babies break down about 30% of their red blood cells in the first month of life, which tends to make a lot of leftover bilirubin. Babies with bruising or birth trauma can break down even more red blood cells.

• Slow livers. Right after a baby is born and cries for the first time, his or her lungs have to start to work harder. A baby’s liver has to do the same, and is usually a little slow getting started.

• Delayed stooling. If a baby is “slow to poop,” he or she may not get rid of the bilirubin in the intestines very quickly. The bilirubin can even get re-absorbed from the gut if the baby doesn’t have many stools in the first few days of life.

• Breastfeeding. For a number of reasons too complex to describe here, breast feeding can cause elevations in bilirubin.

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Checking For Newborn Jaundice

The American Academy of Pediatrics recommends that all babies be checked for jaundice after birth and daily while in the hospital. Your babys provider will check for jaundice with at least one of these methods:

• Blood test. This is the best way to measure bilirubin levels.
• Physical exam. Your babys body is checked for symptoms of jaundice.
• Skin test. A device placed on your babys forehead measures the reflection of a special light that shines through the skin.

The AAP recommends that babies be checked for jaundice again at 3 to 5 days of age. This is the time when bilirubin levels are the highest. If your baby leaves the hospital within 72 hours of birth, a checkup should be scheduled within the next two days. If you cannot get in to see your babys doctor, it is important to still have the checkup. You can take your baby to the nearest childrens hospital to do so.

Breast Milk Jaundice Due To Interference With Liver Function

Though relatively rare, about 10 percent of breastfed babies develop jaundice when a protein in breast milk blocks the liver’s processing of bilirubin, causing elevated levels. It’s rarely harmful, but still requires a doctor’s evaluation in case some other cause is in play. A case can last anywhere from three to 12 weeks.

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Where Does Bilirubin Come From

Bilirubin comes from hemoglobin in old red blood cells. As red cells are broken down in the body, the hemoglobin inside gets converted by enzymes to become bilirubin. The bilirubin is then transported in the blood to the liver. The liver processes it further and then sends it to the gall bladder. The gallbladder then excretes the bilirubin into the intestine, where it goes into the baby’s stool and is eliminated from the body.

Understanding Jaundice: Why Does My Baby Look Yellow

Your babys skin color might be yellow in the days right after birth and thats usually normal. But you need to know when it might be more serious.

About 60 percent of babies have newborn jaundice, which typically doesnt hurt your baby and goes away without treatment. But if your baby has severe jaundice and doesnt get quick treatment, it can lead to brain damage.

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Treating Jaundice At Home

If immediate treatment for jaundice isnt required, or when your baby starts improving after treatment in the hospital, well ask you to monitor symptoms at home. Along with yellowish skin and eyes, symptoms can include extreme sleepiness and difficulty feeding and gaining weight.

Your doctor may recommend:

• Putting your baby in a warm room with a big, sunny window. Take off all the baby’s clothes and let them sit in the sunlight, which can help break down bilirubin, for an hour or two. This method helps prevent UV damage that direct sunlight outside can cause.
• Feeding your baby frequently.The more they eat, the more bowel movements theyll have and the more bilirubin theyll excrete. However, this is not a reason to start supplementing with formula if youre breastfeeding, and theres no reason to ever give water to a newborn.

Jaundice typically develops from the head to the feet. The legs and hands are usually last. If you notice jaundice in these areas, we need to see your baby right away because the jaundice has likely spread through their body and bilirubin levels are high.

Any time you see new or lingering symptoms of jaundice, talk with your childs pediatrician. Follow-up appointments can help your baby avoid serious complications. While treatment isnt always necessary, we wont know unless we measure and monitor your babys bilirubin level.

To visit with a pediatrician about jaundice symptoms or treatment, call orrequest an appointment online.

Treatment For Newborn Jaundice

Most babies with jaundice dont need treatment. If your baby has mild jaundice, you likely will be told to breastfeed your baby more often to get rid of the bilirubin. Jaundice usually clears up within two weeks in formula-fed babies.

If your baby has more severe jaundice, phototherapy treatment may be needed. Wearing just a diaper and eye shields, your baby is placed for 24 to 48 hours under special lights that help change bilirubin into a form that can exit the body in urine. Phototherapy is usually done in the hospital.

If phototherapy doesnt work and your babys bilirubin levels are still high, providers may try a special type of blood transfusion called an exchange transfusion. This process gets rid of bilirubin by replacing your babys blood with fresh blood in small amounts.

If you and your baby have different blood types, your baby may get immunoglobulin through a needle into a vein. This can help treat the jaundice and possibly avoid an exchange transfusion.

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When Should I Worry About My Baby Sleeping Too Much

Chronic sleepiness, though, can sometimes be a cause for concern. If your newborn is regularly sleeping for more than 17 hours a day and is interfering with her ability to eat at least eight times per day, you should let your pediatrician know. Frequently missing meals could hurt her weight gain and growth.

How Is Newborn Jaundice Treated

Mild jaundice will usually resolve on its own as a babys liver begins to mature. Frequent feedings will help babies pass bilirubin through their bodies.

More severe jaundice may require other treatments. Phototherapy is a common and highly effective method of treatment that uses light to break down bilirubin in your babys body.

In phototherapy, your baby will be placed on a special bed under a blue spectrum light while wearing only a diaper and special protective goggles. A fiber-optic blanket may also be placed underneath your baby.

In very severe cases, an exchange transfusion may be necessary in which a baby receives small amounts of blood from a donor or a blood bank.

This replaces the babys damaged blood with healthy red blood cells. This also increases the babys red blood cell count and reduces bilirubin levels.

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How Common Is Jaundice

One of the most prevalent diseases that may afflict newborn newborns is jaundice. It is believed that 6 out of every 10 newborns acquire jaundice, with 8 out of 10 babies delivered prematurely before the 37th week of pregnancy suffering from the condition. However, only around 1 in every 20 newborns has a blood bilirubin level high enough to require therapy.

Jaundice is the yellow color of the skin and eyes due to increased levels of serum bilirubin. It is usually seen within the first few days after birth in infants who are breast-fed or given formula containing little iron. The cause of jaundice is increased production of red blood cells or breakdown of these cells more rapidly than normal causing them to release their contents into the blood stream. Most cases of jaundice go away on their own but some cases can lead to brain damage or even death if not treated quickly.

Breast milk contains antibodies that help protect against bacteria that can cause diarrhea, urinary tract infections, and pneumonia. Babies don’t produce these antibodies when they are being fed formula instead. Therefore, they need additional antibiotics to prevent these infections. Antibiotics do not treat viral infections like colds or flus so giving antibiotics to your baby will not make them better unless it is for a bacterial infection. This is why it is important to know the difference between viral and bacterial infections.

Why Do Newborn Infants Get Jaundice

Jaundice, a golden yellow discoloration of the skin and eyes, is very common in newborns. About 60% of healthy, full term infants have some degree of jaundice in the first week of life. The yellow color is due to a pigment called bilirubin, a by-product of the breakdown of red blood cells. In many newborns, the bilirubin level is high enough for the pigment to accumulate in the baby’s skin, causing the golden color. Usually, the yellow color starts on a baby’s cheeks and face, and then spreads downward to the chest and abdomen.

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Enhancing Healthcare Team Outcomes

Neonatal jaundice is a common condition with varied etiologies. Most cases are benign with an excellent prognosis and resolve with or without treatment. However, bilirubin encephalopathy can complicate clinical course in a few. Health care professionals taking care of newborn needs to be aware of this. While many conditions that cause jaundice cannot be diagnosed right away, education about the disease is critical. Nurses and parents are often the first to notice jaundice in a newborn. After discharge from the birth hospital, parents need to be educated by the nurses, pediatricians, obstetricians, and the family practice providers to monitor for jaundice and seek medical care if it worsens.

Should A Mother Continue Breastfeeding If Her Child Has Jaundice

Supplementation can include mothers expressed breast milk, pasteurized donor human milk, or infant formula.

Usually. Most newborns with jaundice can continue breastfeeding. More frequent breastfeeding can improve the mothers milk supply and, in turn, improve caloric intake and hydration of the infant, thus reducing the elevated bilirubin. In rare cases, some infants may benefit from a time-limited, temporary interruption of breastfeeding with replacement feeding to help aid in the diagnosis of breast milk jaundice. Ongoing clinical assessment, including repeat bilirubin levels, will help determine when breastfeeding can resume. Further guidance is outlined in the Academy of Breastfeeding Medicines clinical protocols on supplementationexternal icon and jaundiceexternal icon. If temporary breastfeeding interruption is required, it is critical to help mothers maintain their milk production during this time.

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What Causes Jaundice In Children

During pregnancy, the mothers liver breaks down the babys bilirubin. After birth, the babys own liver takes over this task. Jaundice occurs when the babys liver is not able to handle extra bilirubin on its own. Because a babys liver is still immature, jaundice is quite common. However, for most newborns, this only lasts for a few days or weeks. After that, the liver of most babies is able to handle bilirubin normally and pass it out of the body so that it wont build up and cause jaundice.

Rarely, jaundice in children may be a sign of a more serious health issue. More testing will then be needed to find the cause and the correct treatment. Some of the health problems that can cause persistent jaundice include:

Rarely Jaundice May Signal A Problem

Sometimes, though, jaundice can be a sign of another problem, and when bilirubin levels get very high it can affect the brain, sometimes in a permanent way. Called kernicterus, this is very, very rare, affecting far less than 1% of infants.

Many conditions make it more likely that bilirubin levels will be high, including:

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When Should I Call My Childs Health Care Provider

• Turning more yellow: Skin that becomes very yellow or orange is cause for concern. This is especially true if the yellow color spreads to the arms or the lower body.
• Feeding poorly: Your baby may have trouble breastfeeding or drinking formula from a bottle. Not eating enough can make jaundice worse.
• Sleepier than usual
• Dehydrated: Signs of dehydration include not enough wet diapers, dark urine, and no tears. If you are concerned about dehydration, remember that babies younger than 6 months of age may only drink formula or breast milk, never water. Pure water can make a newborn or young infant very sick.
• Weak or inactive
• Losing weight or failing to gain weight

• Backward arching neck or body
• Trouble waking up

How Is Jaundice Diagnosed

Doctors can tell if a baby has jaundice based on a yellowing of the skin and whites of the eyes. All newborns are checked for jaundice before leaving the hospital or birth center.

Babies with jaundice will get a blood test to check bilirubin levels. Sometimes, a light machine that measures bilirubin in the skin is used. But if the level is high, a blood test must confirm the result.

High bilirubin levels can lead to serious problems. So doctors carefully watch babies with jaundice.

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Should I Be Worried If My Baby Has Jaundice

Jaundice usually appears on the second or third day. If your baby is full-term and healthy, mild jaundice is nothing to worry about and will resolve by itself within a week or so. However, a premature or sick baby or a baby with very high levels of bilirubin will need close monitoring and medical treatments.

How Common Is Newborn Jaundice

Jaundice is one of the most common conditions that can affect newborn babies.

It’s estimated 6 out of every 10 babies develop jaundice, including 8 out of 10 babies born prematurely before the 37th week of pregnancy.

But only around 1 in 20 babies has a blood bilirubin level high enough to need treatment.

For reasons that are unclear, breastfeeding increases a baby’s risk of developing jaundice, which can often persist for a month or longer.

But in most cases, the benefits of breastfeeding far outweigh any risks associated with jaundice.

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When Is Jaundice Concerning

• Jaundice that develops in the first 24 hours of life. This is one reason why we don’t like to send babies home right after delivery we want to follow their color for the first few days. “Early” jaundice suggests that there might be a different problem going on.

• Very severe jaundice. Bilirubin levels above 20 warrant treatment . In small or premature babies, we might institute treatment sooner.

• Other concerning symptoms. If the baby has any other signs of illness or infection, like fever, lethargy, poor feeding, dehydration, etc., obviously those other symptoms would need to be checked out.

Should A Jaundiced Breastfed Infant Be Supplemented

Sometimes. Jaundice is one of the possible indications for supplementation in healthy, term infants as outlined in the Academy of Breastfeeding Medicines clinical protocols on supplementationexternal icon and jaundiceexternal icon. Any decisions about supplementation of a jaundiced newborn should be made on a case-by-case basis.

• Wambach, K. & Riordan, J. . Breastfeeding and Human Lactation . Jones & Bartlett Learning. Page 405.
• Lawrence, R.A & Lawrence, R.M. . Breastfeeding: A Guide for the Medical Profession . Philadelphia, PA: Elsevier. Page 506.

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How Is Jaundice Diagnosed In A Child

Newborn babies should be tested for jaundice before going home from the hospital or birthing center. Babies at risk for jaundice, or those who are still jaundiced more than usual, might need to be checked again after a few days. Your childs health care provider can tell you if this is needed. If your baby is still jaundiced after 2 weeks of age , your provider will most likely order a blood test for total and direct bilirubin to better understand the type of jaundice and what other tests to do.

Your babys health care provider will first examine your child for signs of jaundice. Other jaundice tests may include a:

• Blood test: which measures the amount of bilirubin in the blood
• Skin test: which uses a special light to measure bilirubin in the skin

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What Are Jaundice And Kernicterus

Jaundice is the yellow color seen in the skin of many newborns. Jaundice happens when a chemical called bilirubin builds up in the babys blood. During pregnancy, the mothers liver removes bilirubin for the baby, but after birth the babys liver must remove the bilirubin. In some babies, the liver might not be developed enough to efficiently get rid of bilirubin. When too much bilirubin builds up in a new babys body, the skin and whites of the eyes might look yellow. This yellow coloring is called jaundice.

When severe jaundice goes untreated for too long, it can cause a condition called kernicterus. Kernicterus is a type of brain damage that can result from high levels of bilirubin in a babys blood. It can cause athetoid cerebral palsy and hearing loss. Kernicterus also causes problems with vision and teeth and sometimes can cause intellectual disabilities. Early detection and management of jaundice can prevent kernicterus.

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