Medically Reviewed by Dr Itender Pal Singh
Newborn jaundice occurs when a baby has a high level of bilirubin in the blood. Bilirubin is a yellow substance that the body creates when it replaces old red blood cells. The liver helps break down the substance so it can be removed from the body in the stool.
A high level of bilirubin makes a baby’s skin and whites of the eyes look yellow. This is called jaundice.
In This Article-
Causes of Jaundice in Newborns
It is normal for a baby’s bilirubin level to be a bit high after birth. When the baby is growing in the mother’s womb, the placenta removes bilirubin from the baby’s body. The placenta is the organ that grows during pregnancy to feed the baby. After birth, the baby’s liver starts doing this job. However, it may take some time for the baby’s liver to be able to do this efficiently, leading to a temporary rise in bilirubin levels.
Most newborns have some yellowing of the skin, or jaundice. This is called physiological jaundice. It is usually noticeable when the baby is 2 to 4 days old. Most of the time, it does not cause problems and goes away within 2 weeks.
In some cases, certain medical conditions can increase the risk of jaundice becoming more severe. Two types of jaundice may occur in newborns who are breastfed. Both types are usually harmless:
- Breastfeeding jaundice occurs in breastfed babies during the first week of life, particularly when they do not nurse well or the mother’s milk is slow to come in, leading to dehydration.
- Breast milk jaundice may appear in healthy, breastfed babies after day 7 of life. It tends to peak during weeks 2 and 3, but may last at low levels for a month or more. This may be due to how certain substances in breast milk affect the breakdown of bilirubin in the liver.
In some cases, severe newborn jaundice may occur if the baby has a condition that increases the number of red blood cells that need to be replaced in the body, such as:
- Abnormal blood cell shapes (such as sickle cell anemia)
- Blood type mismatch between the mother and baby (Rh incompatibility or ABO incompatibility)
- Bleeding underneath the scalp (cephalohematoma) caused by a difficult delivery
- Higher levels of red blood cells, which is more common in small-for-gestational age (SGA) babies and some twins
- Infections
- Lack of certain important proteins, called enzymes
Other conditions that make it harder for the baby’s body to remove bilirubin include:
- Certain medications
- Infections present at birth, such as rubella, syphilis, and others
- Diseases affecting the liver or biliary tract, such as cystic fibrosis or hepatitis
- Low blood oxygen level (hypoxia)
- Genetic or inherited disorders
Babies who are born prematurely are more likely to develop jaundice compared to full-term babies because their livers may not be fully developed to process bilirubin effectively.
Symptoms of Newborn Jaundice
The most noticeable sign of newborn jaundice is a yellowing of the skin and whites of the eyes. It typically begins on the face and gradually spreads downward toward the chest, belly, legs, and finally to the soles of the feet. The severity of jaundice is often judged by how much of the baby’s body appears yellow.
In severe cases, newborns with jaundice may exhibit additional symptoms such as:
- Extreme tiredness (lethargy)
- Poor feeding or difficulty in breastfeeding
- Listlessness or irritability
If jaundice progresses without proper treatment, severe cases can lead to complications like kernicterus, a form of brain damage that can occur due to high levels of bilirubin. This highlights the importance of closely monitoring newborns for signs of jaundice.
Diagnosing Jaundice in Newborns
Healthcare providers typically monitor newborns for signs of jaundice while they are still in the hospital. After going home, it is usually family members who first notice the yellowing of the skin.
If jaundice is suspected, the baby’s bilirubin levels should be checked immediately. This is typically done through a blood test, although some hospitals use skin probes that estimate bilirubin levels non-invasively.
Common tests used to diagnose jaundice include:
- Complete blood count (CBC)
- Coombs test (to check for blood type incompatibility)
- Reticulocyte count (to assess how fast red blood cells are being produced)
In some cases, further tests may be required if the bilirubin levels are rising faster than expected or if treatment is necessary.
Treatment for Newborn Jaundice
For most babies, newborn jaundice resolves on its own without the need for treatment within 1 to 2 weeks. However, if treatment is required, it will depend on several factors:
- The baby’s bilirubin levels
- How quickly bilirubin levels are rising
- Whether the baby was born prematurely
- How old the baby is
In cases where newborn jaundice becomes more severe, several treatment options may be considered:
- Increased feeding: Newborns with jaundice need to take in plenty of fluids, either through breast milk or formula, to encourage bowel movements. This helps eliminate bilirubin through the stools.
- Phototherapy: Special blue lights can be used to break down bilirubin in the skin. The baby is placed under these lights wearing only a diaper, with their eyes protected. Phototherapy can be done in the hospital or, in less severe cases, at home with a fiber-optic blanket.
- IV fluids: In some rare cases, babies may need extra fluids through an intravenous (IV) line.
- Exchange transfusion: In the most severe cases, an exchange transfusion may be required. This procedure involves replacing the baby’s blood with fresh blood to lower bilirubin levels rapidly.
- Intravenous immunoglobulin (IVIG): This treatment may be used for babies with severe jaundice related to Rh incompatibility, as it helps reduce bilirubin levels.
Treatment typically lasts 1 to 2 days and may require the baby to return to the hospital if jaundice worsens after going home.
Prognosis and Complications
For most babies, newborn jaundice is not harmful and resolves without complications. However, in rare cases, a very high bilirubin level can lead to kernicterus, a serious condition that can cause permanent brain damage.
Possible complications of high bilirubin levels include:
- Cerebral palsy
- Hearing loss or deafness
- Developmental delays
- Kernicterus
Fortunately, newborn jaundice is often detected and treated before bilirubin levels reach a critical point. Monitoring and early intervention are key to preventing these complications.
When to Seek Medical Attention
It is important for all newborns to be seen by a healthcare provider within the first 5 days of life to check for jaundice. The American Academy of Pediatrics recommends the following:
- Babies who spend less than 24 hours in the hospital should be seen within 72 hours.
- Babies sent home between 24 and 48 hours should be seen by 96 hours of life.
- Babies discharged between 48 and 72 hours should be seen by 120 hours.
If jaundice worsens, especially if the skin turns bright yellow or the baby shows signs of poor feeding, lethargy, or fever, it should be considered a medical emergency.
Parents should also contact a healthcare provider if:
- Jaundice persists beyond 2 weeks
- The yellow color spreads to the baby’s feet, especially the soles
- Other symptoms such as listlessness or feeding difficulties develop
Prevention of Newborn Jaundice
While some degree of jaundice is normal in newborns, there are steps that can help reduce the risk of severe jaundice:
- Frequent feeding: Ensure that the baby is fed at least 8 to 12 times a day during the first few days of life. This promotes regular bowel movements, which help eliminate bilirubin.
- Blood type testing: Pregnant women should be tested for blood type and unusual antibodies. If the mother is Rh-negative, follow-up testing on the baby’s umbilical cord may be necessary.
- Close monitoring: Newborns should be closely monitored during the first 5 days of life, with bilirubin levels checked if there are signs of jaundice. A follow-up visit should be scheduled within the first week of life for babies sent home within 72 hours of birth.
Newborn jaundice is a common condition that affects many babies shortly after birth. While it can be concerning to see the yellowing of the skin and eyes, jaundice is usually harmless and resolves on its own. However, it is important for parents and healthcare providers to monitor bilirubin levels to prevent severe cases that could lead to complications such as kernicterus.
Through early diagnosis, proper feeding, and timely treatment when necessary, the risks associated with newborn jaundice can be minimized. Parents should stay informed, follow up with their pediatrician, and seek medical advice if they notice any worsening of symptoms or if the jaundice lasts longer than expected.
Sources-
Harrison Manual of Internal Medicine.
Kaplan M, Wong RJ, Burgis JC, Sibley E, Stevenson DK. Neonatal jaundice and liver diseases.
Medline Plus- https://medlineplus.gov/ency/article/001559.htm
Nelson’s Pediatrics Manual.
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