About half of all newborns develop jaundice, a yellowing of a baby’s skin and eyes. Newborn jaundice can occur when babies have a high level of bilirubin, a yellow pigment produced during normal breakdown of red blood cells. In older babies and adults, bilirubin is usually processed by the liver, and then passed through the intestinal tract. However, a newborn’s still-developing liver may not be mature enough to remove bilirubin.
The good news is that in most cases, newborn jaundice goes away on its own as a baby’s liver develops and as the baby begins to feed, which helps bilirubin pass through the body.
In most cases, jaundice will disappear within two to three weeks. Jaundice that persists longer than three weeks may be a symptom of an underlying condition. Additionally, high levels of bilirubin can put a baby at risk for deafness, cerebral palsy, or other forms of brain damage. That’s why the American Academy of Pediatrics (AAP) recommends that all babies be examined for jaundice every time vital signs are measured, or at least every 8 to 12 hours; before discharge from the hospital; and again a few days after discharge. (AAP, 2004)
Causes and Risk Factors
Babies at highest risk for developing newborn jaundice are:
- Premature babies, born before 38 weeks’ gestation.
- Babies who are not getting enough breast milk, either because they are having a hard time feeding or because their mothers’ milk is not in yet.
- Babies whose blood type is not compatible with their mothers’—this may cause a buildup of antibodies that destroy babies’ red blood cells and cause a sudden rise in bilirubin levels.
Other causes of newborn jaundice include bruising at birth or other internal bleeding, infection, liver malfunction, enzyme deficiency, or an abnormality in a baby’s red blood cells.
The first sign of jaundice is a yellowing of a baby’s skin and eyes. The yellowing may begin within two and four days of birth and start in the face before spreading down across the body. Bilirubin levels typically peak between three to seven days after birth.
If a finger lightly pressed on a baby’s skin causes that area of skin to become yellow, it’s likely a sign of jaundice.
When to Call a Doctor
While most jaundice is normal, in some cases it may indicate an underlying medical condition. Severe jaundice also increases the risk of bilirubin passing into the brain, which can cause permanent brain damage. Contact your doctor if you notice the following symptoms:
- jaundice is spreading or becoming more intense
- the baby develops a fever of over 100 degrees Fahrenheit
- yellow coloring deepens
- the baby is feeding poorly, appears listless or lethargic, and making high-pitched cries
Tests and Diagnosis
Most mothers and newborns are discharged from the hosptial within 72 hours of delivery. It’s very important for parents to bring their babies in for a check-up a few days after birth, since bilirubin levels peak between three and seven days after birth.
A distinct yellow coloring confirms that a baby has jaundice, but additional tests are needed to determine how severe the jaundice is.
Babies who develop jaundice in the first 24 hours of life should have bilirubin levels measured immediately, either through a skin or blood test.
Additional tests may be needed to see if a baby’s jaundice is caused by an underlying condition. This may include testing for red blood cell counts, or testing for blood type and Rh incompatibility.
Drugs and Treatments
Mild jaundice will usually resolve on its own as a baby’s liver begins to mature. Frequent feedings—between 8 to 12 times a day—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 a baby’s body. Babies are placed in a special bed under a blue spectrum light, wearing only a diaper and special protective goggles. A fiber optic blanket may also be placed under the baby.
In very severe cases, an exchange transfusion may be necessary. In an exchange transfusion, small amounts of blood are taken from a donor (or from a blood bank) and given to the baby, in essence replacing a baby’s damaged blood with healthy red blood cells. This increases the baby’s red blood cell count and reduces bilirubin levels.
There is no real way to prevent newborn jaundice, but parents can keep jaundice from becoming more severe by taking the following precautions:
- Make sure your baby is getting enough nutrition through breast milk. By feeding your baby 8 to 12 times a day for the first several days, you are making sure your baby is not dehydrated, which helps bilirubin pass through the body more quickly.
- If you are unable to breastfeed and choose to formula feed, give your baby 1 to 2 ounces of formula every two to three hours for the first week.
- During pregnancy, have your blood type and your baby’s blood type tested to rule out the possibility of blood type incompatibility that could lead to newborn jaundice.
- If you notice signs and symptoms of jaundice, call your doctor immediately.