Jaundice is a yellow coloring in your baby’s skin, and sometimes, the whites of the eyes. Newborn jaundice happens during the first weeks of life. There are many types of jaundice, including: Physiologic jaundiceBreastfeeding jaundiceBreast milk jaundice (human milk jaundice syndrome)Jaundice caused by hemolysis or increased bilirubin productionJaundice caused by inadequate liver function (due to inborn errors of metabolism, prematurity, or enzyme deficiencies)
Baby with Jaundice
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The yellow coloring is caused by bilirubin. Bilirubin is a waste product. It is created when red blood cells are broken down. Bilirubin normally passes out of the body through feces or urine. Jaundice occurs when there is an abnormal buildup of bilirubin. Different types of jaundice have different reasons for the abnormal buildup of bilirubin:
May be caused by the breakdown of fetal red blood cells.The baby’s body does not get rid of bilirubin very efficiently in the first days of life.
Occurs in about 13% of breastfed babies.This type of jaundice is caused by dehydration and poor calorie intake. It may happen in babies that are not taking in enough breast milk.
Breast milk jaundice:
Occurs in only 2% of babies.It may be caused by a substance in breast milk that blocks the elimination of bilirubin.
Caused by massive breakdown of red blood cells
May be caused by mismatched blood types in mom and baby such as
Rh diseaseThis type of jaundice will occur within the first 24 hours of life. It occurs before the baby leaves the hospital and can be harmful
Inadequate liver function:
The liver may be impaired by an infection or liver disease.This type of jaundice usually happens before the baby leaves the hospital.
Newborn jaundice is more common in children of East Asian, Mediterranean, or Native American descent.
Factors that may increase your baby’s chance newborn jaundice include: Prematurity—babies born before 36 weeks of pregnancyBrother or sister treated for jaundiceBaby has a different blood type than mother, resulting in hemolysisPoor feeding with breast or bottleLarge bruises or a condition called cephalhematoma (bleeding under the scalp related to labor and delivery)High bilirubin levels or signs of jaundice in the first 24 hours of life (before leaving the hospital)Certain liver enzyme deficienciesInfection
The main symptom of jaundice is yellow skin color. The color usually starts in the face.
The yellow color may then spread down to the stomach and legs. Certain environments may make your baby appear yellow. To look for yellow skin, place your baby near a window or in a room with fluorescent light. If you are still unsure, press gently on the baby’s forehead or chest. Watch as the color reappears.
Call your baby's doctor if you suspect your baby has jaundice.
If your baby has been diagnosed with jaundice, call your doctor if: Yellow color gets deeperYellow color spreads to other parts of the body or the eyesJaundice lasts for more than 3 weeks
Very high levels of bilirubin in your baby’s blood can be dangerous. It can lead to a very rare form of brain damage called kernicterus. It is important to see a doctor if your baby has signs of this condition. Call the doctor immediately if your baby: Is tired all the time or difficult to wakeSucks or nurses poorlyLooks weak or floppyArches his or her back or neck backwardsDevelops a high-pitched cry or feverHas convulsions or spasms
The American Academy of Pediatrics recommends that all babies are assessed for jaundice before they leave the hospital. Your baby will be checked again at 3-5 days of age. If your doctor suspects jaundice, you will be asked about your baby’s symptoms and medical history. A physical exam will be done.
Tests may include: Examination of baby’s skinTranscutaneous bilirubin (TcB)—a light is passed through the baby's skin to screen for high bilirubin levelsBlood test—to check level of bilirubin in blood. This may be done if TcB shows a risk for high bilirubin levels
Most babies with jaundice will not need treatment. Jaundice in formula-fed infants will usually clear up in two weeks. In breastfed babies, jaundice usually clears up in 2-3 weeks.
If your child does need treatment, talk with the doctor about the best treatment plan. Treatment options include:
Increased breastfeeding can help clear bilirubin from your baby's body. Your doctor may ask you to aim for 8-12 feeding per 24-hour period. Do not let your baby sleep for more than 4 hours without feeding during this time period. If you are having any problems breastfeeding, ask your doctor or lactation specialist for help.
Babies that are formula-fed will need to get extra formula. Ask the doctor for guidelines as to how much formula you should provide. You may need to give your baby 1-2 ounces (30-60 milliliters) of formula every 2-3 hours.
For most jaundice, extra breastfeeding is helpful. However, breast milk jaundice is caused by the breast milk. Your doctor may recommend stopping breastfeeding for a couple days. This will let the bilirubin decrease. Once the jaundice has cleared, it is safe to resume breastfeeding.
Phototherapy is the use of special lights. The lights help alter the bilirubin in the blood. The bilirubin can then easily pass in the urine or through the gastrointestinal tract.
Your baby will be placed naked, or wearing only a small diaper, under special blue or white lights. A shield will help to protect your baby's eyes.
may be done at home or in the hospital.
These light are specially designed to treat the bilirubin without harming your baby's skin. Putting your baby in the direct sunlight is NOT recommended. Direct sunlight on a naked baby can cause dangerous sunburn.
In the most severe cases of jaundice, your doctor may recommend a blood transfusion. A transfusion will replace your baby’s blood with new blood. The excess bilirubin will be removed with the blood.
There are no current guidelines to prevent newborn jaundice.
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http://familydoctor.org/familydoctor/en/diseases-conditions/jaundice.html. Updated April 2014. Accessed September 15, 2015.
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http://kidshealth.org/parent/pregnancy_center/newborn_care/jaundice.html. Updated January 2015. Accessed September 15, 2015.
Muchowski KE. Evaluation and treatment of neonatal hyperbilirubinemia. Am Fam Physician. 2014;89(11):873-878.
Neonatal cholestasis. EBSCO DynaMed website. Available at:
http://www.ebscohost.com/dynamed. Updated May 2, 2014. Accessed September 15, 2015.
Neonatal hyperbilirubinemia. EBSCO DynaMed website. Available at:
http://www.ebscohost.com/dynamed. Updated August 24, 2015. Accessed September 15, 2015.
Neonatal hyperbilirubinemia. The Merck Manual Professional Edition website. Available at:
http://www.merckmanuals.com/professional/pediatrics/metabolic_electrolyte_and_toxic_disorders_in_neonates/neonatal_hyperbilirubinemia.html. Updated August 2015. Accessed September 15, 2015.
Last reviewed September 2015 by Kari Kassir, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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