Jaundice in Babies

Jaundice (yellow coloring of the skin and eyes) starting on about the 3rd or 4th day after birth can be seen in about 60% of full term babies (babies who are born after about nine month’s pregnancy). It is even more common in babies who are born early. Some babies will need treatment for the jaundice, while for most the jaundice will not last long (between 1 and 2 weeks) and not cause problems even without treatment.

What Causes Jaundice?

• Jaundice is caused by high levels of a chemical called bilirubin in the baby's body.

• Red blood cells are being made, and being broken down continually in all people, including babies before and after birth, because red blood cells, like most other cells in the body, have a limited lifespan, and after several weeks they do not work as well as newly made cells. The protein in the red blood cells that makes them red is called hemoglobin. This protein breaks down into smaller chemicals before it can be eliminated (got rid of) from the body. Bilirubin is one of these chemicals.

• Before birth the chemicals made when the baby's hemoglobin breaks down are carried out of the baby through the umbilical cord to the placenta, and into the mother's blood. The mother's body then gets rid of them with her own waste products.

• When a baby is born, the baby's liver suddenly has to take over the work of getting rid of hemoglobin and it can take the liver a few days to fully manage this. While this is happening the level of bilirubin in the baby's body rises, causing the yellow color - jaundice.

Which Babies Get Jaundiced?

• All babies have a raised bilirubin level for several days, but in healthy full term babies this may not be noticeable, or if it is, the level is usually still low and not a problem.

• Some babies who have a lot of bruising when they are being born also have a lot of damaged red blood cells (in the bruise) which need to be broken down, and these babies can develop a high bilirubin level.

• Some breast-fed babies (about 5%) will also have higher levels of bilirubin, in part due to some of the chemicals that are naturally in the breast milk (including an enzyme called ί-glucuronyl transferase). In the early days after birth, before the breast milk 'comes in' the baby may be getting less fluid and less calories than in a bottle fed baby (this is not harmful) slowing down the elimination of bilirubin. 'Breastfeeding jaundice' may last for several weeks.

• In some babies, especially premature babies, or ones who are sick for some other reason (e.g. they have an infection), the bilirubin level goes higher, and a very high bilirubin level can cause some severe health problems.

• Some babies who have a blood group different to their mother's blood group may also have jaundice

Health Problems from Neonatal Jaundice

• Some babies with a moderate level of bilirubin will be a bit more sleepy than usual, and may not feed well.

• If the level of bilirubin in a baby's blood rises to a very high level, it can damage parts of the brain including parts that affect hearing, vision and control of movement (called kernicterus).

• The level of bilirubin that will be harmful depends on how mature and how well the baby is. A large, full term, healthy baby can have a higher level without problems than can a sick or premature baby.

Testing for Neonatal Jaundice

• Since many babies are sent home within the first 2 days of life, parents will need to watch their baby for signs of jaundice.

• Jaundice appears first on the face and head. If the level goes higher, it will appear on the body, and if it goes even higher it will be on the palms of the hands and soles of the feet.

• A simple test is to gently press your fingertip on the tip of your child's nose or forehead. If, when you lift your fingertip off, the skin is white, there is no jaundice. If there is a yellowish color, contact your doctor.

• If a child appears to be jaundiced, a blood test can be done to work out the level of bilirubin, and the decision about treatment will depend on the level and how healthy the baby is.

Treatment for Neonatal Jaundice

• Most babies who are well and who are mildly jaundiced will not need treatment. As the liver matures, it will break the bilirubin into other chemicals which can be passed out through the gut.

• Phototherapy (or light therapy) may be used for babies whose level is getting higher. Light energy helps change the bilirubin that is just under the skin into a different, and less harmful, chemical. Babies may be placed under special lights that make the most effective wavelengths of light (the baby's eyes will be covered to protect them from the intense light).

• If the levels of bilirubin get very high, the baby may need an exchange transfusion (the baby's blood is replaced with other blood, sometimes from the mother). This is rare.

What You Can Do About Neonatal Jaundice

• If your baby is starting to look yellow, make sure the baby is checked by a doctor or a health care worker.

• If your baby seems unwell (for example is not feeding well or has a fever), and is starting to look yellow, it is even more important to have the baby checked soon.

• If your baby is well, is starting to look jaundiced and is being breastfed, it may be breast milk jaundice. Breast milk is still best for your baby. Increasing feeds may help. Rarely it may be necessary to stop breast feeding for a few days. Check with your doctor or a lactation consultant.

• If phototherapy lights are not available, putting a baby next to a window where there is lots of indirect light (not direct light from the sun) may be recommended, but this does not work as well as phototherapy.

References:
McDougall P et al 'Neonatal Pediatrics' in Smart J, Nolan T (Eds) 'Pediatric Handbook: Royal Children's Hospital, Melbourne' Sixth Edition, 2000 Blackwell Science

Medline Plus (US National Library of Medicine) 'Breast milk Jaundice'

Medline Plus (US National Library of Medicine) 'Newborn Jaundice', www.nlm.nih.gov

National Center on Birth Defects and Developmental Disabilities (USA) 'Kernicterus', www.nlm.nih.gov

www.cdc.gov