Jaundice in Newborns: What Parents Need to Know

What is jaundice?

Jaundice is a yellowish discoloration of the skin and eyes that is caused by a buildup of a chemical called bilirubin in the blood. It is not accurate to assess jaundice severity by inspection alone, so doctors will often measure the bilirubin in the blood to better assess the severity of the jaundice.

What causes jaundice?

Normally, bilirubin enters the blood stream with the normal turnover of red blood cells in the body.  It is then processed in the liver, released into the digestive tract, and finally excreted from the body.  Disruptions in this process cause elevated bilirubin and thus jaundice.

Newborns are particularly susceptible to jaundice due to the following:

• Newborns are born with a higher red blood cell compared to older children and adults
• Newborn livers are not as effective at clearing bilirubin from the blood early on.
• Newborn intestines are more likely to absorb the bilirubin instead of excreting it.
• Newborns are naturally a little dehydrated in the first few days of life which can concentrate the bilirubin level even more.

Some factors raise this baseline risk in newborns even further:

• Birth trauma and bruising that exacerbates red blood cell turnover
• Incompatibility between a mom and baby’s blood type exacerbates red blood cell turnover
• Prematurity
• Siblings with hyperbilirubinemia requiring phototherapy treatment
• East Asian race
• Infection

Less commonly, newborns with abnormalities in their red blood cells, enzyme deficiencies or liver malfunctions.

How do I know if my baby has jaundice?

Most babies will have some degree of elevated bilirubin. This is why all babies will have one jaundice test before being discharged from the hospital.

Since bilirubin levels naturally rise over the first four days of life, it is important for newborns to be seen in the office within a few days of being discharged from the hospital.  When you leave the hospital, you should be told how soon you need to bring your newborn into the office.

In the office your doctor will take various factors into consideration (like your baby’s appearance, weight, feeding/stooling patterns) to determine if a blood test needs to be done to quantify the jaundice.

What are the symptoms of jaundice?

Besides the yellow discoloration to the skin, symptoms of elevated bilirubin in newborns include difficulty with feeding, poor sucking, and excess sleepiness.  These symptoms should always prompt an evaluation of your baby.

Can jaundice hurt my baby?

When the bilirubin levels get excessively high, they can pass to the brain cells and cause permanent damage.  This can result in kernicterus which impacts brain development.

This is very rare, but the main reason why your pediatrician will monitor bilirubin levels so closely. There are no known risks to the lower levels of jaundice that your pediatrician monitors or treats.

How is jaundice treated?

Most of the time, jaundice in newborns is monitored and does not require treatment.  When the levels are rising, your pediatrician may suggest some forms of treatment to help prevent the continued rise of the bilirubin and associated complications.

Formula supplementation. In the early days when breastmilk is not readily available, formula supplementation is often suggested.  This helps treat the newborn’s dehydration and also stimulates the intestines to excrete the bilirubin.  This is usually only suggested temporarily as breastmilk is definitely the preferred form of nutrition for newborns.

Phototherapy.  If the bilirubin levels are elevated, newborns may be treated with this blue light therapy.  The blue light helps convert the bilirubin to a water soluble form that the body can excrete.  Phototherapy can either be done in the hospital or in the home setting.  The bilirubin level is monitored on this treatment, and usually most babies only require this treatment for 1-2 days.

During this time, moms and newborns continue to work on breastfeeding. Usually by the time the phototherapy is discontinued, babies have gained weight and have an improved feeding pattern.

Blood transfusions. For rare and severe cases that do not respond to above treatments, blood transfusions can be helpful.