A common condition in newborns, jaundice refers to the yellow
color of the skin and whites of the eyes caused by excess bilirubin
in the blood. Bilirubin is produced by the normal breakdown of red
blood cells.
Normally, bilirubin passes through the liver and is excreted as
bile through the intestines. Jaundice occurs when bilirubin builds
up faster than a newborn's liver can break it down and pass it
from the body. Reasons for this include:
- Newborns make more bilirubin than adults do since they have
more turnover of red blood cells.
- A newborn baby's still-developing liver may not yet be
able to remove adequate bilirubin from the blood.
- Too large an amount of bilirubin is reabsorbed from the
intestines before the baby gets rid of it in the stool.
High levels of bilirubin - usually above 25 mg - can cause
deafness,
cerebral palsy
, or other forms of brain damage in some babies. In less
common cases, jaundice may indicate the presence of another
condition, such as an infection or a thyroid problem. The American
Academy of Pediatrics (AAP) recommends that all infants should be
examined for jaundice within a few days of birth.
Types of Jaundice
The most common types of jaundice are:
Physiological (normal) jaundice:
occurring in most newborns, this mild jaundice is due to the
immaturity of the baby's liver, which leads to a slow
processing of bilirubin. It generally appears at 2 to 4 days of age
and disappears by 1 to 2 weeks of age.
Jaundice of prematurity:
occurs frequently in
premature babies
since they are even less ready to excrete bilirubin effectively.
Jaundice in premature babies needs to be treated at a lower
bilirubin level than in full term babies in order to avoid
complications.
Breastfeeding jaundice:
jaundice can occur when a breastfeeding baby is not getting enough
breast milk because of difficulty with breastfeeding or because the
mother's milk isn't in yet. This is not caused by a problem
with the breast milk itself, but by the baby not getting enough to
drink.
Breast milk jaundice:
in 1% to 2% of
breastfed
babies, jaundice may be caused by substances produced in their
mother's breast milk that can cause the bilirubin level to
rise. These can prevent the excretion of bilirubin through the
intestines. It starts after the first 3 to 5 days and slowly
improves over 3 to 12 weeks.
Blood group incompatibility (Rh or ABO problems):
if a baby has a different blood type than the mother, the mother
might produce antibodies that destroy the infant's red blood
cells. This creates a sudden buildup of bilirubin in the baby's
blood. Incompatibility jaundice can begin as early as the
first day of life. Rh problems once caused the most severe form of
jaundice, but now can be prevented with an injection of
Rh immune globulin
to the mother within 72 hours after delivery, which prevents her
from forming antibodies that might endanger any subsequent
babies.
Symptoms and Diagnosis
Jaundice usually appears around the second or third day of life.
It begins at the head and progresses downward. A jaundiced
baby's skin will usually appear yellow first on the face,
followed by the chest and stomach, and finally, the legs. It can
also cause the whites of an infant's eyes to appear yellow.
Since many babies are now released from the hospital at 1 or 2
days of life, it is best for the baby to be seen by a doctor within
1 to 2 days of leaving the hospital to check for jaundice. Parents
should also keep an eye on their infants to detect jaundice.
If you notice your baby's skin or eyes looking yellow you should
contact your child's doctor to see if significant jaundice is
present.
At the doctor's office, a small sample of your infant's
blood can be tested to measure the
bilirubin level
. Some offices use a light meter to get an approximate measurement,
and then if it is high, check a blood sample. The seriousness of
the jaundice will vary based on how many hours old your child is
and the presence of other medical conditions.
When to Call the Doctor
Your doctor should be called immediately if:
- jaundice is noted during the first 24 hours of life
- the jaundice is spreading or getting more intense
- your baby develops a fever over 100º Fahrenheit (37.8º
Celsius) rectally
- if your child starts to look or act sick
Also call the doctor right away if the color deepens, your baby
is not feeding well, or if you feel your baby is sleepier than
usual. It is difficult to tell how significant jaundice is just by
looking at a baby, so any baby who has yellow eyes or skin should
be checked by the doctor.
Treatments
In mild or moderate levels of jaundice, by 1 to 2 weeks of
age the baby will take care of the excess bilirubin on its own. For
high levels of jaundice, phototherapy - treatment with a special
light that helps rid the body of the bilirubin by altering it or
making it easier for your baby's liver to get rid of it - may
be used.
More frequent feedings of breast milk or supplementing with
formula to help infants pass the bilirubin in their stools may also
be recommended. In rare cases, a blood exchange may be required to
give a baby fresh blood and remove the bilirubin.
If your baby develops jaundice that seems to be from breast
milk, your doctor may ask you to temporarily stop breastfeeding.
During this time, you can pump your breasts so you can keep
producing breast milk and you can start nursing again once the
condition has cleared.
If the amount of bilirubin is high, your baby may be readmitted
to the hospital for treatment. Once the bilirubin level drops and
the treatment is stopped, it is unlikely that treatment for
jaundice will need to be restarted.
Reviewed by:
Larissa Hirsch, MD
Date reviewed: June 2008
Note: All information is for educational purposes only. For specific medical advice,
diagnoses, and treatment, consult your doctor.
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