What is Jaundice?
Over half of all newborns develop some amount of jaundice, a yellow coloring in their skin, during the first week of life. This is usually temporary, but could be a sign of a more serious illness.
Jaundice is caused by the breakdown of red blood cells. Bilirubin is made during this process and removed by the liver. Too much bilirubin in the blood is called hyperbilirubinemia. Bilirubin has a yellow color and causes a yellowing of the baby's skin and tissues.
As liver function matures, the jaundice goes away.
Types of Jaundice
There are several types of jaundice:
- Physiologic jaundice: occurs as a "normal" response to the baby's limited ability to get rid of bilirubin in the first days of life.
- Breastfeeding jaundice: occurs in the first few days to a week of life. It is caused by the baby not taking enough breast milk or a low breast milk supply.
- Breast milk jaundice syndrome: about 2% of healthy breastfed babies develop jaundice after the first week. It is associated with a decreased ability to get rid of the bilirubin because of the breast milk.
- Jaundice from the breakdown of red blood cells due to hemolytic disease of the newborn (Rh disease), having too many red blood cells, or bleeding.
- Jaundice related to poor liver function due to infection or other factors.
Why Is Jaundice a Concern?Although low levels of bilirubin are not usually a concern, large amounts can build up in the brain and may cause seizures and brain damage. This is a condition called kernicterus.
Symptoms of Jaundice
Common symptoms may include:
- Yellow coloring of the baby's skin, usually beginning on the face and moving down the body
- Poor feeding or lethargy
Testing for Hyperbilirubinemia / Jaundice
Testing for hyperbilirubinemia / jaundice may include:
- Blood tests
- Direct and indirect bilirubin levels show if the bilirubin is bound with other substances by the liver so that it can be removed by the liver (direct), or is circulating in the blood and unable to be removed (indirect).
- Red blood cell counts
- Blood type and testing for Rh incompatibility (Coombs' test)
- Transcutaneous bili-meter measures the levels in the skin
Treatment for Jaundice
Specific treatment will be determined by your baby's doctor based on:
- Your baby's gestational age, overall health, and medical history
- Extent of the disease
Treatment may include:
- Phototherapy: Jaundice and increased bilirubin levels usually decrease when the baby is exposed to special blue lights. Phototherapy takes several hours to begin working and is used throughout the day and night. The baby's eyes must be protected, and temperature monitored during treatment.
- Fiberoptic blanket: Another form of phototherapy is a fiberoptic blanket placed under the baby. This may be used alone or in combination with regular phototherapy.
- Exchange transfusion: This replaces the baby's blood with fresh blood to help lower the levels of bilirubin.
- Treatment of underlying conditions: Treating any underlying cause of hyperbilirubinemia, such as infection.