Newborn jaundice is when a baby has high levels of bilirubin in the blood. Bilirubin is a yellow substance that the body creates when it replaces old red blood cells. The liver helps break down the substance so it can be removed from the body in the stool.
High levels of bilirubin makes your baby's skin and whites of the eyes look yellow. This is called jaundice.
Jaundice of the newborn; Neonatal hyperbilirubinemia; Bili lights - jaundice
It is normal for a baby's bilirubin level to be a bit higher after birth.
When the baby is growing in the mother's womb, the placenta removes bilirubin from the baby's body. The placenta is the organ that grows during pregnancy to feed the baby. After birth, the baby's liver starts doing this job. This can take a while.
Most newborns have some yellowing of the skin, or jaundice. This is called "physiological jaundice." It is harmless, and usually is worst when the baby is 2 - 4 days old. It goes away within 2 weeks and doesn't usually cause a problem.
Two types of jaundice may occur in newborns who are breast fed. Both types are usually harmless.
Severe newborn jaundice may occur if your baby has a condition that increases the number of red blood cells that need to be replaced in the body, such as:
Things that make it harder for the baby's body to remove bilirubin may also lead to more severe jaundice, including:
Babies who are born too early (premature) are more likely to develop jaundice than full-term babies.
Jaundice causes a yellow color of the skin. The color sometimes begins on the face and then moves down to the chest, belly area, legs, and soles of the feet.
Sometimes, infants with significant jaundice have extreme tiredness and poor feeding.
Doctors, nurses, and family members will watch for signs of jaundice at the hospital, and after the newborn goes home.
Any infant who appears jaundiced should have bilirubin levels measured right away. This can be done with a blood test.
Many hospitals check total bilirubin levels on all babies at about 24 hours of age. Hospitals use probes that can estimate the bilirubin level just by touching the skin. High readings need to be confirmed with blood tests.
Tests that will likely be done include:
Further testing may be needed for babies who need treatment or whose total bilirubin levels are rising more quickly than expected.
Treatment is usually not needed.
When determining treatment, the doctor must consider:
Your child will need treatment if the bilirubin level is too high or is rising too quickly.
Keep the baby well hydrated with breast milk or formula. Frequent feedings (up to 12 times a day) encourage frequent bowel movements, which help remove bilirubin through the stools. Ask your doctor before giving your newborn extra formula.
Some newborns need to be treated before they leave the hospital. Others may need to go back to the hospital when they are a few days old. Treatment in the hospital usually lasts 1 to 2 days.
Sometimes special blue lights are used on infants whose levels are very high. This is called phototherapy. These lights work by helping to break down bilirubin in the skin.
The infant is placed under artificial light in a warm, enclosed bed to maintain constant temperature. The baby will wear only a diaper and special eye shades to protect the eyes. The American Academy of Pediatrics recommends that breastfeeding be continued through phototherapy, if possible. Rarely, the baby may have an intravenous (IV) line to deliver fluids.
If the bilirubin level is not too high or is not rising quickly, you can do phototherapy at home with a fiberoptic blanket, which has tiny bright lights in it. You may also use a bed that shines light up from the mattress.
In the most severe cases of jaundice, an exchange transfusion is required. In this procedure, the baby's blood is replaced with fresh blood. Treating severely jaundiced babies with intravenous immunoglobulin may also be very effective at reducing bilirubin levels.
Usually newborn jaundice is not harmful. For most babies, jaundice usually gets better without treatment within 1 to 2 weeks.
Very high levels of bilirubin can damage the brain. This is called kernicterus. However, the condition is almost always diagnosed before levels become high enough to cause this damage.
For babies who need treatment, the treatment is usually effective.
Rare, but serious, complications from high bilirubin levels include:
All babies should be seen by a health care provider in the first 5 days of life to check for jaundice.
Jaundice is an emergency if the baby has a fever, has become listless, or is not feeding well. Jaundice may be dangerous in high-risk newborns.
Jaundice is generally NOT dangerous in term, otherwise healthy newborns. Call the infant's health care provider if:
In newborns, some degree of jaundice is normal and probably not preventable. The risk of significant jaundice can often be reduced by feeding babies at least 8 to 12 times a day for the first several days and by carefully identifying infants at highest risk.
All pregnant women should be tested for blood type and unusual antibodies. If the mother is Rh negative, follow-up testing on the infant's cord is recommended. This may also be done if the mother's blood type is O+, but it is not needed if careful monitoring takes place.
Careful monitoring of all babies during the first 5 days of life can prevent most complications of jaundice. Ideally, this includes:
American Academy of Pediatrics (AAP). Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation. Pediatrics. 2004;114:297-316.
Mercier CE, Barry SE, Paul K, et al. Improving newborn preventive services at the birth hospitalization: a collaborative, hospital-based quality-improvement project. Pediatrics. 2007;120:481-488.
Moerschel SK, Cianciaruso LB, Tracy LR. A practical approach to neonatal jaundice. Am Fam Physician. 2008;77:1255-1262.