Jaundice in Newborns Should not be Ignored

by Srisatish Devapatla, MD, FAAP

Jaundice is a very common condition in newborn babies. More than 50 percent of babies develop jaundice and it often resolves on its own. However, when jaundice does not resolve quickly it is critical for parents to take steps to treat it because a sustained level of jaundice can be quite detrimental to the baby.

What exactly is jaundice?

Jaundice is yellowish discoloration of the skin and mucous membranes due to a pigment called bilirubin. This pigment is released from red blood cells when they break down. When babies are born they have a higher red blood cell count than healthy adults, and the red blood cells of babies live only three months, as compared to four months in an adult. The result, for a newborn baby, is an overload of bilirubin coupled with an immature liver that can’t work fast enough to process this excess bilirubin. This increased load of bilirubin stains the skin yellowish-orange.

What should parents of newborns expect as the normal course of events?

In a full-term baby, the bilirubin rises steadily from the time of birth, peaks at about four days, and then drops back down. In babies born prematurely, the bilirubin peaks in five or six days, and then drops down. Because the majority of full-term newborns leave the hospital setting before their jaundice peaks and begins to drop down, it is important that parents know to look for signs of jaundice and stay in close contact with their pediatricians. Premature infants stay in the hospital a little longer so their jaundice is typically treated before they are discharged.

What should parents look for as signs of jaundice?

View your baby naked in natural light. Look for yellow skin and yellow staining of the whites of the eyes. Apply gentle pressure with your thumb to the skin on the baby’s forehead: if you see yellow discoloration when you remove your thumb, your baby has jaundice. Jaundice spreads from head to toe. Bilirubin levels are high if hands and feet are yellow stained.

Other signs of jaundice include decreased activity of the baby, poor feeding, dry lips, and a decreased number of diapers. These are all signs of dehydration, which is one of the characteristics of jaundice.

Why is it dangerous to leave jaundice untreated?

While most jaundice in newborns is harmless, an inappropriately high level of bilirubin affects the brain temporarily. Left untreated, a sustained level of high bilirubin can cause permanent brain damage, deafness, seizures, and an unusual form of cerebral palsy. This type of permanent brain damage is called kernicterus.

What is the recommended follow-up once the newborn leaves the hospital?

Your baby should be seen by the medical care provider between three to five days of life. The exact timing will vary based on your circumstances.

If you have had a home-birth or very early discharge from a hospital birth and you notice signs of jaundice in the first 24 hours after birth, this is not normal and you should call a doctor immediately.

How is jaundice treated if it doesn’t resolve?

In the follow-up visit, the medical care provider will check the baby’s weight and talk with parents about the adequacy of breast milk intake and voiding and stool patterns. The doctor may also check the serum bilirubin level. Sometimes this is done by heel-prick blood test or by using a noninvasive probe on the surface of the skin. This probe, which is called a transcutaneous biliometer, is used at Cayuga Medical Center and makes a needle-stick unnecessary in many cases. If the bilirubin is high, the baby will be treated with phototherapy, also called light therapy. In rare cases of serious jaundice, the doctor may recommend an exchange of blood, which requires a blood transfusion.

Are there other types of jaundice?

Yes, there are other types of jaundice in newborns and these conditions need to be addressed.

Breastfeeding jaundice, which occurs during the first week of life, is due to dehydration in the baby because the mother is not producing enough milk. This is treated by more frequent breastfeeding, supplemented with feedings of formula, not water or sugar-water.

Breast-milk jaundice, which occurs after the first week of life, is caused when substances in the breast milk cause bilirubin in the baby’s intestines to be reabsorbed by the body. Treatment requires a mother to stop breastfeeding for two days while the bilirubin is monitored, during which time the baby consumes formula. Mothers continue to pump breast milk during this time, until they resume normal feeding. Breastfeeding should never be permanently discontinued due to breast-milk jaundice.

Dr. Devapatla is a pediatrician who is board certified in neonatal-perinatal medicine. He is the medical director of the Level 2 Special Care Nursery at Cayuga Medical Center. He completed his pediatric residency at Metropolitan Hospital Center, New York Medical College, and did his fellowship training in neonatal-perinatal medicine at MetroHealth Medical Center, Case Western Reserve University.

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