Jaundice

Overview

Jaundice is a common condition in newborns, affecting 50 percent to 60 percent of full-term babies and 80 percent of those born prematurely. It can give babies' skin and the whites of their eyes a yellowish tint.

Jaundice is caused by excess levels of bilirubin, which is a yellow pigment produced when old red blood cells break down. Normally, bilirubin passes through the liver and is excreted as bile through the intestines. However, when a newborn's immature liver can't process bilirubin fast enough, it can build up in the blood, making the baby's skin turn a yellowish color.

In most babies, jaundice goes away on its own or with mild treatment. However, in some cases when a baby has very high levels of bilirubin, close monitoring and treatment in the Intensive Care Nursery may be needed. If jaundice isn't treated appropriately, babies may experience permanent damage to their nervous system, called kernicterus. Kernicterus is a rare condition that can cause deafness, delayed development or a form of cerebral palsy.

Types of jaundice

There are several types of newborn jaundice. The following are the most common:

• Physiological jaundice — This type of jaundice affects 50 to 60 percent of full-term newborns in their first week, typically three to five days after birth. It occurs when a baby's liver can't sufficiently process bilirubin. Typically this condition disappears within one to two weeks. Because their livers are less mature, premature babies are more likely to have this form of jaundice.
• Blood group incompatibility jaundice — In some cases when a baby and mother have different blood types, the mother produces antibodies that destroy her infant's red blood cells. As a result, bilirubin builds up in the baby's blood. This condition may be diagnosed before birth or the first day after birth. In some cases, it can be avoided by treating the mother with a drug that will prevent her from forming antibodies against her baby.
• Breast milk jaundice — A very small number of breastfed babies, roughly one to two percent, develop jaundice because of substances in their mother's breast milk that cause their bilirubin levels to rise.

Signs & symptoms

Although not always obvious, the hallmark symptom of jaundice is a yellowish tint to a baby's skin and the whites of the eyes. Jaundice usually appears two to three days after birth. The yellowish tint typically affects the baby's face first, then the chest and stomach and ultimately the legs. Jaundice may also occur with infection or with certain disorders of the gastrointestinal tract.

Because jaundice can develop in your baby after discharge from the hospital, parents are advised to check their baby's skin tone for a yellowish tint in natural or fluorescent lighting. A simple test for jaundice is to press your fingertip to your baby's nose or forehead. If the pressed skin has a yellowish tint, then your baby may have jaundice and you should call your doctor immediately.

Diagnosis

In addition to a complete physical examination to check for signs of jaundice, the doctor may also do a blood test to measure the level of bilirubin in your baby's blood. If your baby does have jaundice, the condition and your baby's treatment options will be explained to you before any therapy is started.

Treatment

Mild or moderate forms of jaundice will usually go away without specific treatment after five to seven days, as the baby's liver becomes more mature. In babies with higher levels of bilirubin, close monitoring — and possibly treatment — is needed.

Light therapy, also called phototherapy, is the usual treatment for jaundice. Phototherapy chemically breaks down the bilirubin in your baby's skin to non-toxic forms. During this treatment, your baby is placed under special white or blue light for one to two days. Their eyes will be covered to protect them from the bright lights.

If phototherapy isn't effective, and your baby's bilirubin levels continue to increase, a procedure known as an exchange transfusion may be necessary. During an exchange transfusion, the infant's blood is gradually removed and replaced with donor blood. This procedure removes bilirubin and lowers the bilirubin to safer, non-toxic levels.