Jaundice

Jaundice
Reviewed by the BabyCenter Medical Advisory Board
Last updated: January 2005

I think my baby 's skin looks a little yellow. Is this normal?

Yes, about 50 to 60 percent of full-term babies have a yellowish cast to their skin — called jaundice — during their first week or two of life. In fact, virtually all newborn babies have some jaundice, but it's not always noticeable. For most babies, this is a temporary, harmless condition that will go away on its own or with mild treatment. But in rare cases, it can be very serious, so it's important to keep an eye on it.
What causes jaundice?

High levels of a pigment in the blood called bilirubin cause the skin to look yellow. When old red blood cells break down, one of the byproducts they create is bilirubin. Everyone's blood contains bilirubin, which is normally removed from the blood by the liver and then eliminated in the stool. Before your baby was born, your liver removed his bilirubin for him. Now it's just taking some time for his liver to take over the task — so the pigment builds up in his blood and his skin takes on the yellowish cast of jaundice.

This type of jaundice, called physiologic jaundice, usually appears on a baby's second or third day of life and disappears on its own within two weeks. (For premature babies, it peaks at five to seven days and may take up to two months to go away.) The yellow color tends to appear first in a baby's face, then move downward to his neck and chest and on down until, in extreme cases, it reaches his toes.
Is jaundice sometimes caused by breastfeeding?

If your baby is breastfeeding, it's possible for him to get jaundice if he doesn't get enough breast milk. That's because if your baby isn't taking in sufficient fluid, he may not be able to eliminate the excess bilirubin through his stools.

If this is the case for your baby, you'll want to discuss the feeding problem with your doctor. You may also want to work with a lactation consultant on breastfeeding. Once your baby is getting enough breast milk — through improved breastfeeding technique, more frequent feedings, or supplementation with formula — the jaundice will likely go away. The American Academy of Pediatrics (AAP) recommends that you breastfeed your baby at least eight to 12 times a day for the first several days.

Some babies develop something called "breast-milk jaundice" during their first few weeks. It's usually diagnosed at around 7 to 11 days of age. Although your baby may be nursing well and gaining weight normally, something in the breast milk interferes with his liver's ability to process bilirubin. This often happens along with physiologic jaundice, and it can go on for several weeks or even months. It's pretty common in exclusively breastfed babies, though, and is generally considered harmless. If your baby's bilirubin levels get too high, your practitioner may recommend that you stop nursing for a day or two to bring them down. (You can use a breast pump to maintain your milk supply during this time, and once the bilirubin is down, you can begin breastfeeding again.)

What's the danger?

Again, in the vast majority of cases, jaundice isn't anything to worry about. But if a baby's bilirubin levels get too high — because his jaundice goes without any treatment and the levels continue to rise — it can cause permanent damage to the nervous system. A very small percentage of jaundiced newborns develop a condition called kernicterus, which can result in deafness, delayed development, or a form of cerebral palsy.
Are some babies more prone to jaundice than others?

Yes, a baby is more likely to have noticeable jaundice if he:

• has a sibling who had jaundice

• had bruises at birth (the red blood cells that are part of the bruises are broken down and produce bilirubin as a byproduct)

• was born prematurely, because his immature liver may not be able to handle the bilirubin levels.
Are there tests for jaundice?

Your medical team will examine your baby for jaundice at birth. Ideally, they should also look at him three to five days after birth, when his bilirubin levels are likely to be highest. If there's any concern that your baby is jaundiced, his doctor may do a skin test or blood test to check his bilirubin levels. (She will definitely do the test if your baby appears jaundiced in the first 24 hours, because jaundice that appears then is more likely to be a problem.)

If you leave the hospital soon after your baby's birth, though, you and your baby may be home by the time jaundice shows up, and you may be the first to notice it. Here's how to check for jaundice: Take your baby into a room with plenty of natural or fluorescent light. If your child is fair-skinned, gently press your finger to his forehead, nose, or chest, and look for a yellow tinge to the skin as the pressure is released. If your child has dark skin, check for yellowness in his gums or the whites of his eyes.
Should I call my baby's doctor?

Yes, talk with his doctor if your baby's skin is yellowish, especially if the whites of his eyes, his tummy, or his arms or legs are yellow. Also call the doctor if your baby is jaundiced and becomes hard to wake or fussy, or doesn't want to eat, and if he has even a mild case of jaundice for over three weeks.
When is jaundice considered serious?

If your baby develops jaundice in the first 24 hours after birth, it's always considered serious and he'll need close monitoring and treatment. This type of jaundice is uncommon, though, and is usually due to a blood-type incompatibility between mom and the baby. If your blood type is O or Rh-negative, it may be incompatible with your baby's blood type. During your first prenatal appointment, your practitioner probably checked your blood type to see if you were at risk for this, but there's no way to know for sure until your baby is born and you find out what his blood type is.

If your practitioner is concerned about incompatible blood types, she'll take a blood sample from your baby at birth to find out his blood type. (Some practitioners will wait to do the blood test until a baby shows signs of developing jaundice, since he may be fine even if your blood types aren't compatible.) She'll also do a "Coombs test" to see if an incompatibility has affected your baby's blood cells, causing him to become jaundiced. If the doctor determines that your baby does have a blood-type incompatibility and/or a positive Coombs test, she'll watch him closely for jaundice.

Jaundice during a baby's first 24 hours can also be caused by serious conditions such as liver, gallbladder, and intestinal disorders, an infection, excessive birth trauma, or extreme prematurity (birth before 28 weeks gestation).
How is jaundice treated?

Most jaundice needs no treatment, but when it does, phototherapy (light therapy) is considered very safe and effective: Placing your baby under blue "bililights" lights — naked in a bassinet, with his eyes covered — will often do the trick because ultraviolet light changes the bilirubin to a form that your baby can more easily dispose of in his urine. Another option involves wrapping your baby in a fiber-optic blanket called a bili-blanket or bili-pad. With a prescription from your doctor, you may be able to rent one of these blankets to treat your baby at home.

Phototherapy is usually effective, but if a baby develops a severe case of jaundice, or his bilirubin levels continue to rise despite phototherapy treatment, he may need to be admitted to the intensive care unit for a blood transfusion called an "exchange transfusion."

Something else you can do on your own to help reduce jaundice is make sure that your baby is getting plenty of breast milk or formula — so he'll have frequent bowel movements. If you have any concerns about jaundice, check with his doctor to make sure you're taking the right steps to get your baby back in the pink.

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