Jaundice in Newborns (Hyperbilirubinemia)
What is jaundice in newborns?
Jaundice is a condition that makes a newborn's skin and the white part of the eyes look yellow. It happens because there is too much bilirubin in the baby's blood (hyperbilirubinemia). Bilirubin is a substance that is made when the body breaks down old red blood cells.
Jaundice usually is not a problem. But in rare cases, too much bilirubin in the blood can cause brain damage (kernicterus). This can lead to hearing loss, intellectual disability, and other problems.
In healthy babies, some jaundice almost always appears by 2 to 4 days of age. It usually gets better or goes away on its own within a week or two without causing problems.
In breastfed babies, mild jaundice sometimes lasts until 10 to 14 days after birth. In some breastfed babies, it goes away and then comes back. Jaundice may last throughout breastfeeding. This isn't usually a problem as long as the baby gets enough milk by being fed at regular times.
Babies who have jaundice need a follow-up examination within the first 5 days after birth. Before or after that visit, your doctor may ask you to watch for signs that the jaundice is going away or to bring your baby in for a test to check if the jaundice is getting better. Call your doctor if the yellow colour gets brighter after your baby is 3 days old.
What causes jaundice in newborns?
Jaundice occurs because your baby's body has more bilirubin than it can get rid of. Bilirubin is made when the body breaks down old red blood cells. It leaves the body through urine and stool. During pregnancy, your body removes bilirubin from your baby through the placenta. After birth, your baby's body must get rid of the bilirubin on its own.
Breastfed newborns can become dehydrated easily if feedings are spaced too far apart. This lack of enough milk in the body makes it harder for your baby to get rid of wastes such as bilirubin. Also, some of the things that make up breast milk can change the way the body removes bilirubin.
In rare cases, too much bilirubin may be caused by infections, a problem with the baby's digestive system, or a problem with the mom's and baby's blood types (Rh incompatibility). Your baby may have one of these problems if jaundice appears less than a day after birth.
What are the symptoms?
Jaundice can make your baby's skin and the white part of the baby's eyes look yellow. You may see the yellow colour between 1 and 4 days after birth. It shows up first in the baby's face and chest. Babies who have bilirubin levels that are too high may have a high-pitched cry. They also may be sluggish and cranky.
How is jaundice in newborns diagnosed?
Your baby's doctor will do a physical examination and ask you questions. The doctor may ask about:
- Your general health, especially during your pregnancy.
- Whether your baby was born early (prematurely) or at full term.
- Whether there were any problems with the birth.
- Your baby's birth weight and whether the baby has lost or gained weight since birth.
- Your baby's feeding and elimination habits.
- Your blood type and whether you and the baby have a problem with Rh incompatibility.
- Any family history of health problems that could cause jaundice.
A blood test for bilirubin may be done to find out if your baby needs treatment.
More tests may be done if the doctor thinks that a health problem is causing too much bilirubin in the blood.
How is it treated?
Most of the time no treatment is needed for jaundice, because it usually goes away on its own. If you are breastfeeding, you may be able to help reduce the jaundice by feeding your baby about 8 to 12 times a day.
Sometimes babies with jaundice are put under a type of fluorescent light. This is called phototherapy. The skin absorbs the light. This changes the bilirubin so that the body can more easily get rid of it in the stool and urine. The treatment is usually done in a hospital. But babies sometimes are treated at home.
If a health problem caused the jaundice, your baby may need other treatment.
Frequently Asked Questions
Learning about jaundice in newborns (hyperbilirubinemia):
Living with jaundice in newborns:
Your newborn's skin and white part of the eyes will look yellow if he or she has jaundice. This yellow tint usually appears first in the infant's face and chest between 1 and 5 days after birth, although the exact timing may vary by child and by the type of jaundice.
- Sluggishness and poor sucking ability.
- Irritability, jitteriness, and crying.
- Arching of the baby's back.
- A shrill, high-pitched cry.
Signs of a very high level of bilirubin may include:
- Periods of not breathing (apnea) or difficulty breathing (dyspnea).
Examinations and Tests
Your baby's doctor will do a physical examination and take a medical history to diagnose jaundice (hyperbilirubinemia). As part of the medical history, the doctor may ask questions about:
- Your general health, particularly during the pregnancy.
- Whether your baby was born prematurely or at full term.
- Whether your baby had any difficulties during delivery.
- Your baby's birth weight and whether there has been any weight gain or loss since birth.
- Your baby's feeding and elimination habits since birth.
- Whether the baby and you have incompatible blood types (ABO or Rh incompatibility).
- Your family history of health conditions that could cause jaundice.
During the examination, the doctor will check your baby's skin colour. This may include pressing a finger lightly on your baby's skin. The doctor will note whether yellowing related to jaundice is visible only in the eyes, face, and head or if it is also noticed on the chest and lower body. He or she may also look for signs of underlying conditions that can cause jaundice.
The doctor or nurse may place a device (transcutaneous metre) gently against your baby's skin to check your baby's bilirubin level. If the results are concerning, a bilirubin test may be done to more precisely measure the bilirubin level in your baby's blood. The results will help your baby's doctor decide whether treatment is needed.
If the doctor thinks that another condition is causing your baby to have too much bilirubin in the blood, more tests may be done. For example, the doctor may do blood type tests if the cause of hyperbilirubinemia could be that you and your baby have different blood types (ABO or Rh incompatibility).
Many mothers and their newborns leave the hospital within 48 hours of the baby's birth, often before signs of jaundice start. Your baby needs a follow-up examination within the first 5 days after birth. Call your baby's doctor if at any time you notice a yellow tinge to your baby's skin and eyes.
Most of the time no medical treatment is needed for jaundice in a newborn (hyperbilirubinemia). But watch for increasing intensity of the yellow tint in the skin and eyes or any change in your baby's behaviour.
Babies who have bilirubin in their blood at a level that could be harmful need treatment. Whatever the cause, if the condition is not treated, too much bilirubin in the blood may lead to brain damage (kernicterus), which could result in hearing loss, intellectual disability, and other problems.
If your baby needs treatment, he or she will likely have phototherapy. It uses a type of fluorescent light to help your baby's body get rid of bilirubin. Standard phototherapy is usually done in a hospital.
If your newborn is receiving phototherapy for jaundice in the hospital, you can help by:
- Asking whether you can stay in the hospital overnight so you can continue to care for your baby. If you are not able to stay, visit frequently.
- Soothing your baby if he or she is fidgety.
- Holding your baby during feedings and during the times he or she is taken out from under the light.
The fluorescent lights used in phototherapy for babies with jaundice are not harmful if precautions are taken. Eye shields are placed over the baby's eyes to protect them while under the light. The shields are removed during feedings. Babies are accustomed to being in the dark after months in the womb, so the shields should not bother your baby.
If the baby's jaundice is being caused by an underlying condition, other treatments may be needed. For example, if severe jaundice is caused by the baby's body destroying red blood cells (blood type incompatibility), the baby may need immunoglobulin (IG). If that doesn't help, the baby may need to be admitted to a hospital and given a blood transfusion.
Parents are often asked to watch their newborns for signs of jaundice, which produces a yellow tint to the skin and eyes. Many mothers and their newborns leave the hospital within 48 hours of the baby's birth, often before signs of jaundice develop. It is recommended that your infant have a follow-up examination with your doctor within the first 5 days after birth.
If your baby has jaundice but does not need phototherapy, your baby's doctor will ask you to watch for and report any signs of increasing jaundice or changes in behaviour. To check for signs of increasing jaundice:
- Undress your baby and look at his or her skin closely twice a day. For dark-skinned babies, look at the white part of the eyes to check for jaundice. Remember that your baby will get cold quickly when undressed. Cover your baby after about 1 minute.
- Check your baby at the same time of day, in the same room, under the same lighting conditions each time. If you think that your baby's skin is getting more yellow, call your doctor.
If your baby is being treated at home for jaundice, be sure you understand how to use all of the equipment. Ask your baby's doctor for help if you have questions or concerns. You may need to take your baby to a lab each day to get his or her bilirubin checked. A home health nurse may visit to make sure all is going well.
If your baby has been treated with phototherapy, the yellow tint to the baby's skin and eyes may not disappear immediately. But if the yellow tint intensifies, report it to your doctor.
It's not good to try to treat your baby's jaundice on your own by placing your baby outside in the sun, under lights in your home, or near a window in the sunlight. Your baby's skin may get burned by the lights or the sun. Also, your baby may get too cold. Special lights and controlled surroundings are always needed to treat jaundice safely.
Some mothers who breastfeed their babies are concerned that they will need to stop breastfeeding if their babies develop jaundice. The Canadian Paediatric Society encourages women to continue breastfeeding newborns who have jaundice who are otherwise healthy.footnote 1 If your baby needs help getting enough milk, you can use a lactation aid or ask your doctor or a lactation consultant to help your baby latch on better.
If your baby is hospitalized, you may need to pump your breasts to maintain your milk production. You can then take the milk to the hospital for your baby's feedings.
- Fetus and Newborn Committee, Canadian Paediatric Society (2007, reaffirmed 2011). Guidelines for detection, management and prevention of hyperbilirubinemia in term and late preterm newborn infants (25 or more weeks' gestation). Paediatrics and Child Health, 12(5): 1B–12B. Also available online: http://www.cps.ca/english/statements/fn/fn07-02.htm.
Other Works Consulted
- American Academy of Pediatrics (2009). Jaundice section of Infant nutrition and development of gastrointestinal function. In RE Kleinman, ed., Pediatric Nutrition Handbook, 6th ed., pp. 47–49. Elk Grove Village, IL: American Academy of Pediatrics.
- Jardine LA, Woodgate P (2011) . Neonatal jaundice, search date February 2010. BMJ Clinical Evidence. Available online: http://www.clinicalevidence.com.
- Kamath BD, et al. (2011). Jaundice. In SL Gardner et al., eds., Merenstein and Gardner's Handbook of Neonatal Intensive Care, 7th ed., pp. 531–552. St. Louis: Mosby Elsevier.
- Kissoon N (2008). Jaundice. In JM Baren et al., eds., Pediatric Emergency Medicine, pp. 340–344. Philadelphia: Saunders Elsevier.
- Lee HC, Madan A (2011). Hematologic abnormalities and jaundice. In CD Rudolph et al., eds., Rudolph's Pediatrics, 22nd ed., pp. 226–233. New York: McGraw-Hill.
- Maheshwari A, Carlo WA (2011). Digestive system disorders. In RM Kliegman et al., eds., Nelson Textbook of Pediatrics, 19th ed., pp. 600–612. Philadelphia: Saunders.
Primary Medical Reviewer John Pope, MD - Pediatrics
Andrew Swan, MD, CCFP, FCFP - Family Medicine
Specialist Medical Reviewer Chuck Norlin, MD - Pediatrics
Current as ofNovember 20, 2015
Current as of: November 20, 2015
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