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Neonatal Jaundice

Dr. Milroy J Samuel

Reviewed by
Dr. Milroy J Samuel

A small percentage of newborn babies lose their gorgeous pink color and glowing complexion soon after birth due to the development of neonatal jaundice. The skin of a child with neonatal jaundice will have a yellowish appearance, as will the whites of the eyes. This yellow color is almost always harmless, and it usually goes away within a few days after the baby is born—although in extremely rare cases, excessively high levels of a substance called bilirubin in an infant’s bloodstream (due to untreated or improperly treated neonatal jaundice) may lead to brain damage.

Causes of Neonatal Jaundice

As alluded to above, our blood naturally contains a small amount a substance known as bilirubin, which is thought to serve as an antioxidant. It is formed from the breakdown of hemoglobin, the red pigment contained in blood cells whose purpose is to carry oxygen in the red blood cells. In newborns, however, it is possible for bilirubin to build up faster than it can be eliminated by the liver through the intestinal tract. This is because the infant’s liver may not yet have matured enough to effectively remove the bilirubin from the baby’s bloodstream. This jaundice is generally not harmful, however, and usually clears up within a few days or sometimes weeks. This is the most common cause for neonatal jaundice.

Neonatal jaundice is more common in premature babies (babies born before 37 weeks of pregnancy) and also early-term babies (those born between 37 and 38 weeks).

In rare cases, newborn jaundice can be a sign of a more serious condition:

  • Sepsis (infection in the bloodstream)
  • Internal bleeding
  • Viral infection (such as viral hepatitis)
  • Genetic enzyme deficiency
  • Blood type incompatibility between mother and child
  • Liver dysfunction

Other Types of Neonatal Jaundice

  • Breastfeeding jaundice: This problem arises when the baby is not getting enough breast milk, for whatever reason. In some cases it may occur only because the mother has not yet begun to produce breast milk. The baby becomes dehydrated, and this causes the level of bilirubin in the blood to increase.
  • Breast milk jaundice: This condition may be caused by naturally occurring substances in the mother’s breast milk that prevent the baby’s body from excreting bilirubin. Breast milk jaundice typically appears when the baby is about a week old and clears up within a month, with no harm done.

Diagnosing Neonatal Jaundice

The simplest method for looking for possible jaundice in newborns is to press gently on the infant’s nose or forehead. If the spot where you pressed looks yellow, chances are the infant has jaundice. Nurses in the hospital do this frequently. Medically, the condition is diagnosed by measuring the level of bilirubin in the baby’s blood. There are different ways to do this, including a scanner type device that is merely placed on the baby’s skin on the forehead or chest. Elevated levels can be confirmed by getting a drop of blood from the baby’s heel (this procedure is called a “heel stick”).

Such examinations are routine at most hospitals. The American Academy of Pediatrics recommends that all newborns be checked for jaundice at least every eight to twelve hours until they leave the hospital. Bilirubin levels generally peak within three to seven days of birth. If the level increases rapidly in the first 12–24 hours of life, this can be a cause for concern, and treatment may be required.

If you and your baby are discharged from the hospital less than 72 hours after the baby’s birth, you should make an appointment to have your doctor check for jaundice within the next few days following your discharge.

Neonatal Jaundice Complications

While jaundice in newborns is normally nothing to be concerned about, your doctor will still want to examine you and your baby carefully because in some cases it may be a symptom of a gallbladder or liver problem. Jaundice is also sometimes a symptom of viral hepatitis.

If the jaundice is severe enough and is not treated, an infant may be susceptible to acute bilirubin encephalopathy, a condition that occurs because bilirubin in large amounts is toxic to brain cells. Warning signs of this condition include fever, vomiting, poor sucking while nursing, and high-pitched crying while arching the back and neck. If not treated, this condition can lead to kernicterus, a form of brain damage that results in uncontrolled, involuntary movements; hearing loss; a permanent upward gaze; and possibly a condition like cerebral palsy

Risk Factors for Jaundice in Newborns

  • Early delivery (birth prior to 38 completed weeks).
  • Bruising during birth — childbirth can be physically traumatic for mother and baby alike, and if your baby is badly bruised in the process, he or she may have higher bilirubin levels (bilirubin is what causes the yellowish appearance of skin surrounding a bruise).
  • Difficult birth leading to blood in the scalp (cephalohematoma), which can occur after the use of a vacuum extractor or forceps, but sometimes can develop spontaneously if the pushing phase was long.
  • Breastfeeding — while most experts recommend breastfeeding, there are some infants who have trouble nursing, or who do not get the fluid and nutrition they need from it; these infants will be at greater risk for jaundice.

Treatment of Neonatal Jaundice

The condition is usually temporary, and often resolves itself without the need for any kind of medical intervention. The best treatment for jaundice is usually to breastfeed more often, and for longer periods. Your doctor may want to make sure that your baby is feeding correctly—i.e., that the baby is latching on to the nipple properly and is able to extract and swallow all the milk. Sometimes the baby will need supplementation with formula if the jaundice is thought to be due to dehydration.

In certain cases a jaundiced newborn may be given phototherapy. This treatment involves exposing the baby to a special light that breaks the bilirubin down into a form that can be excreted through the urine rather than the liver. This is often the case if the bilirubin levels are high in the first 24 hours of life. Phototherapy is safe and very effective.

While neonatal jaundice is rarely a cause for serious concern, you should call your doctor if the yellow color does not go away within three days of birth.

Questions to Ask Your Doctor About Neonatal Jaundice

  • Should I be concerned about my baby’s yellow complexion?
  • Do you think my baby should receive phototherapy, or do you expect that the jaundice will go away on its own within a few days?
  • Does my baby appear to be breastfeeding normally?
  • Is this an ordinary case of neonatal jaundice, or is there some underlying condition that we should be concerned about

Medical References:

    U.S. Department of Health and Human Services http://www.womenshealth.gov/publications/our-publications/fact-sheet/viral-hepatitis.html http://www.womenshealth.gov/breastfeeding/common-challenges/ http://www.womenshealth.gov/glossary/ http://www.womenshealth.gov/publications/our-publications/when-call-baby-doctor.pdf Stanford School of Medicine http://newborns.stanford.edu/Jaundice.html The Mayo Clinic http://www.mayoclinic.org/diseases-conditions/infant-jaundice/basics/definition/con-20019637 National Institutes of Health http://www.nlm.nih.gov/medlineplus/jaundice.html http://www.nlm.nih.gov/medlineplus/ency/article/001559.htm http://en.wikipedia.org/wiki/Neonatal_jaundice Sedlak, T. W.; Saleh, M.; Higginson, D. S.; Paul, B. D.; Juluri, K. R.; Snyder, S. H. (2009). "Bilirubin and glutathione have complementary antioxidant and cytoprotective roles". Proceedings of the National Academy of Sciences 106 (13): 5171–6.
[Page updated June 2015]