Newborn Jaundice

Jaundice, a yellow coloring of the skin and eyes, occurs commonly in newborns, and is usually noticed around the second or third day of life. It is caused by elevated levels of bilirubin (a breakdown product of red blood cells) in the blood, is usually harmless and usually goes away on its own. Should you notice it, however, discuss with your healthcare provider what to do next.

Because very high levels of bilirubin can damage the brain of a newborn, interventions to lower the levels may be necessary.

Jaundice is first seen in the eyes and face, and then down the body as bilirubin levels rise. It may not be noticed immediately in infants with dark skin. One way to check for jaundice is to press lightly on the skin and look for a yellow color in the blanched area when you lift your finger. If you see this yellow color, your baby most likely has jaundice.

When bilirubin is released into the blood, it travels to the liver where it is processed and enters the intestines as bile, which is excreted in bowel movements.

Babies at Risk
Newborns — especially premature babies — are at risk for developing jaundice because:
1. They have high levels of red-blood-cell breakdown, particularly if they were bruised during birth.
2. Their livers are not fully mature, and bilirubin is processed slowly.
3. Their initial small feedings, especially in breastfed infants, may not produce enough bowel movements to remove the bile.
4. Less commonly, babies and mothers may have a blood group incompatibility leading to increased red-blood-cell breakdown, or substances in breast milk may prevent the excretion of bilirubin in bowel movements.

Some rare but serious illnesses may also be present with jaundice early in life.

All newborns’ bilirubin levels are measured starting when they are about 24 hours old, and then periodically during the first week based on how jaundiced they appear. Many hospitals and healthcare providers’ offices use light meters placed on the skin to test painlessly. If the reading is high, a blood test is often done to confirm the result. Since levels tend to rise naturally over the first three to four days of life, a faster-than-normal rise may be as or more concerning as a single high level.

Treatment Options
Treatment of jaundice usually begins with giving babies extra food (breast milk or formula supplements). This helps to get things moving in the intestines so bile can be excreted through bowel movements. Supplemental feedings can be given without harming the development of good breastfeeding habits.

If the bilirubin level is high enough, babies will be given ultraviolet light — or phototherapy — similar to a tanning bed. This light helps to process the bilirubin in the skin so it can be excreted in the urine.

Severe jaundice may require a blood transfusion, but this is rare.

What Moms and Dads Can Do
The best ways to prevent problems from jaundice are to make sure your newborn is feeding regularly, to keep track of wet and dirty diapers and to watch for any yellow color of your baby’s skin that appears or increases. Once newborn jaundice resolves, it should no longer be an issue. If you have a concern, let your provider know.

Pediatrician Elizabeth Shashaty, MD, is on staff at Children’s National Medical Center and Medstar Georgetown University Hospital, both in Washington, DC. She is also the mother of three young children.