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Should Your Child See a Doctor?

Jaundiced Newborn

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Definition

  • The skin and whites of the eyes have turned yellow

Types of Jaundice

Physiological jaundice (50% of newborns) 

  • Onset 2 to 3 days of age
  • Peaks day 4 to 5, then improves
  • Disappears 1 to 2 weeks of age

Physiological jaundice (50% of newborns) 

  • Onset 2 to 3 days of age
  • Peaks day 4 to 5, then improves
  • Disappears 1 to 2 weeks of age

Breastfeeding or malnutrition jaundice (5 to 10% of newborns) 

  • Due to inadequate intake of breastmilk
  • Pattern similar to physiological type
  • Also, causes poor weight gain

Breastmilk jaundice (1% of newborns) 

  • Due to substance in breastmilk which blocks destruction of bilirubin
  • Onset 4 to 7 days of age
  • Lasts 3 to 10 weeks
  • Not harmful

Rh and ABO blood group incompatibility 

  • Onset during first 24 hours of life
  • Can reach harmful levels

When to Call Your Doctor for Jaundiced Newborn

Call 911 If…

 
  • Your child is unresponsive or difficult to awaken
  • Your child is not moving or very weak
 

Call Your Doctor Now (night or day) If

  • Newborn starts to look or act abnormal (e.g., decrease in activity or ability to suck)
  • Feeding poorly (e.g., little interest, poor suck, doesn't finish)
  • Signs of dehydration (no urine in 8 hours, very dry mouth, sunken soft spot)
  • Fever above 100.4° F (38.0° C) rectally (Caution: Do NOT give your baby any fever medicine before being seen)
  • Low temperature below 96.8° F (36.0° C) rectally that doesn't respond to warming
  • Jaundice began during the first 24 hours of life
  • Skin looks deep yellow or orange
  • Jaundice has reached the legs
  • Jaundice worse than when last seen
  • High-risk baby for severe jaundice (premature baby of 36 weeks or earlier, ABO or Rh blood group problem, sibling needed bili-lights, cephalohematoma, Asian race, breastfeeding problems)
  • You think your child needs to be seen
 

Call Your Doctor Within 24 Hours (between 9 am and 4 pm) If

 
  • You are concerned about the degree of jaundice (exception: only the whites of eyes are yellow)
  • You are concerned your baby is not getting enough breastmilk
  • Good-sized yellow, seedy stools are less than 3 per day (EXCEPTION: breastfed and before 5 days of life)
  • Day 2-4 of life and no stool in over 24 hours and breastfed
  • Wet diapers are less than 6 per day (EXCEPTION: 3 wet diapers/day can be normal before 5 days of life if breastfed)
  • Discharged before 48 hours of life AND 4 or more days old AND hasn't been examined since discharge (Reason: AAP recommends re-check)
  • You have other questions or concerns
 

Call Your Doctor During Weekday Office Hours If

  • Color gets deeper after 7 days old
  • Jaundice is not gone after 14 days of age
  • Jaundice began or reappeared after 7 days of age
  • Stools are white, pale yellow or gray
 

Parent Care at Home If

  • Mild jaundice of newborn and you don't think your child needs to be seen
 

Home Care Advice for Mild Jaundice

  1. Reassurance:
    • Some jaundice is present in 50% of newborns.
    • It is temporary and usually harmless.
    • The first place for jaundice to appear is in the whites of the eyes (sclera).
    • Jaundice that only involves the face and eyes is always harmless.
  2. Bottlefed: If bottle fed, increase the frequency of feedings. Try for an interval of every 2 to 3 hours during the day.
  3. Breastfed: If breastfed, increase the frequency of feedings. Nurse your baby every 1½ to 2½ hours during the day. Don't let your baby sleep more than 4 hours at night without a feeding.
  4. Increase Stools:
    • If your baby is 5 days or older AND has less than 3 stools/day, carefully insert a lubricated thermometer ½ inch (12 mm) into the anus and gently move it from side to side a few times to stimulate a stool.
    • Reason: increased stools carry more bilirubin out of the body
    • Do this once or twice per day until jaundice improves or stool frequency becomes normal.
     
  5. Expected Course: Physiological jaundice peaks on day 4 or 5 and then gradually disappears over 1-2 weeks.
  6. Judging Jaundice:
    • Jaundice starts on the face and moves downward. Try to determine where it stops.
    • View your baby unclothed in natural light near a window.
    • Press on the skin with a finger to remove the normal skin tone.
    • Then try to assess if the skin is yellow before the pink color returns.
    • Move down the body, doing the same. Try to assess where the yellow color stops.
    • Jaundice that only involves the face and eyes is always harmless. As it involves the chest, the level is going up. If it involves the abdomen, arms or legs, the bilirubin level needs to be checked.
     
  7. Call Your Doctor If:
    • Jaundice becomes worse
    • Legs become yellow
    • Feeding poorly or weak suck
    • Baby starts to act sick or abnormal
    • Jaundice not gone by day 14
     

And remember, contact your doctor if your child develops any of the "When to Call Your Doctor" symptoms.


References

  1. American Academy of Pediatrics, Provisional Committee for Quality Improvement. Practice parameter: management of hyperbilirubinemia in the healthy term newborn. Pediatrics. 1994;94:558-565.
  2. American Academy of Pediatrics, Subcommittee on Hyperbilirubinemia. Clinical Practice Guideline: Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation. Pediatrics. 2004;114(1):297-316.
  3. American Academy of Pediatrics, Subcommittee on Neonatal Hyperbilirubinemia Neonatal jaundice and kernicterus. Pediatrics. 2001;108:763-764
  4. Bhutani V, Johnson L and Keren R. Treating acute bilirubin encephalopathy-before it’s too late. Contemp Pediatr. 2005;22(5):57-74.
  5. Chiu A. Unconjugated hyperbilirubinemia. In: Moyer V, Davis RL, Elliott E, et al, eds. Evidence Based Pediatrics and Child Health. London, England: BMJ Publishing Group; 2000. p. 306-312
  6. Dixit R and Gartner LM. The jaundiced newborn: Minimizing the risks. Contemp Pediatr. 1999;16(4):166-183.
  7. Gartner LM, Herrarias CT, Sebring RH. Practice patterns in neonatal hyperbilirubinemia. Pediatrics. 1998;101:25-31.
  8. Gartner LM. Neonatal jaundice. Pediatr Rev. 1994;15:422-432.
  9. Kramer LI. Advancement of dermal icterus in the jaundiced newborn. Am J Dis Child. 1969;118:454.
  10. Maisels MJ, McDonagh AF. Phototherapy for neonatal jaundice. N Engl J Med. 2008;358:920-928.
  11. Maisels MJ. Neonatal jaundice. Pediatr Rev. 2006;27(12):443-454.
  12. Maisels MJ. Jaundice in a newborn. Contemp Pediatr. 2005;22(5):34-54.
  13. Moyer VA, Ahn C, Sneed S. Accuracy of clinical judgment in neonatal jaundice. Arch Pediatr Adolesc Med. 2000;154:391-394.
  14. Palmer HR, Clanton M, Ezhuthachan S, et al. Applying the 10 simple rules of the institute of medicine to management of hyperbilirubinemia in newborns. Pediatrics.. 2003;112(6):1388-1393.
  15. Riskin A, Tamir A, Kugelman A, et al. Is visual assessment of jaundice reliable as a screening tool to detect significant neonatal hyperbilirubinemia? J Pediatr. 2008;152:782-786.

Disclaimer

This information is not intended to be a substitute for professional medical advice. It is provided for educational purposes only. You assume full responsibility for how you choose to use this information.

Author and Senior Reviewer: Barton D. Schmitt, M.D.

Last Reviewed: 8/1/2010

Last Revised: 9/17/2010 10:45:59 AM

Copyright 1994-2011 Barton D. Schmitt, M.D.

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