 |
|
Quick Reference and Fact Sheets |
|
|
|
|
 |
|
|
|
|
| |
Newborn Jaundice
What is newborn jaundice?
Jaundice is a yellow discoloration of the skin and the whites of the eyes. It is caused by a build-up of a yellow pigment called bilirubin in the blood. Jaundice occurs in about 50 to 60 percent of all newborns.1 Skin usually starts to turn yellow a few days after birth.2 In most cases, jaundice goes away without treatment and does not harm the baby or cause any discomfort. However, in severe cases, jaundice can pose a risk of brain damage.
The American Academy of Pediatrics recommends that all babies be checked for jaundice before they leave the hospital.2,3 Babies should be examined again by a doctor or nurse at three to five days of age because this is the time when bilirubin levels are highest.2,3 When necessary, a baby can be treated to prevent jaundice from reaching serious levels.
How are babies checked for jaundice?
A health care provider will examine the baby for signs of jaundice before being discharged from the hospital. If the baby's skin looks yellow or if the baby has certain risk factors that make jaundice more likely (see below), the provider may measure the level of bilirubin with a skin test or a blood test. The blood test is the most accurate way to determine the severity of jaundice. One of these tests also may be recommended for some babies with darker skin because it may be difficult to tell if a baby has jaundice by examining the skin.
What causes jaundice in newborns?
Jaundice occurs when bilirubin builds up in the blood. Each day some red blood cells in the body die. As they break down, an oxygen-carrying substance called hemoglobin is changed to bilirubin.
Normally, the liver removes bilirubin from the blood and changes it into a form that can be passed from the body in bowel movements. In newborns, more red blood cells can break down than at most other times, creating more bilirubin to handle. The liver of a newborn may be too immature to keep up with bilirubin removal, so bilirubin builds up in the blood. This build-up turns skin and, sometimes, the white part of eyes yellow. Premature babies have especially immature livers, making jaundice more likely.
Jaundice caused by a maturing liver is often called physiologic jaundice. This is the most common type of jaundice in newborns, occurring in both breastfed and formula-fed infants. Physiologic jaundice usually clears up within two weeks in formula-fed babies, though it may last for more than two to three weeks in breastfed infants.2
Certain health problems in the baby also can contribute to jaundice. In these cases, jaundice may begin in the first 24 hours of life and become more serious. A small number of babies have different blood types from their mothers (such as ABO or Rh incompatibility) that can lead to an especially rapid breakdown of red blood cells and jaundice. Certain newborn digestive system disorders, infections and genetic disorders also can contribute to jaundice, as can severe bruising at birth. These babies are more likely than babies with physiologic jaundice to require treatment to reduce the levels of bilirubin in their blood. When bilirubin levels get too high, bilirubin can enter the brain and cause brain damage.
Are breastfed babies more likely to develop jaundice?
Breastfed babies are more likely than formula-fed infants to develop jaundice.2 However, severe jaundice occurs mainly in babies who are not nursing well.2,3 These babies may not get enough calories and may become dehydrated, both of which may contribute to severe jaundice. Breastfeeding mothers should nurse their babies at least eight to 12 times a day for the first several days of life to help keep their baby's bilirubin level down.3The American Academy of Pediatrics recommends that all healthy full-term and near-term babies be breastfed.3 Breast milk is the ideal food for babies and provides many health benefits, including reducing the risk of infections.
What are the symptoms of jaundice?
Yellow discoloration usually first appears on the face, then the chest. Jaundice then may spread downward to the stomach and legs. A parent often can tell if a baby has jaundice by looking at the baby under natural daylight or in a room that has fluorescent lights. If there is a yellowish color or if there is a doubt, a parent should contact the baby's health care provider. Parents of a baby who has already been diagnosed with jaundice also should call their health care provider if skin turns more yellow, jaundice spreads to the abdomen, arms or legs, or if the whites of the baby's eyes are yellow.2
Most babies with jaundice have no other symptoms. They are alert and eat and sleep normally. However, a parent should call the baby's health care provider immediately or seek emergency medical care if the baby develops increased sleepiness or is hard to wake, sucks or nurses poorly, appears weak or floppy, arches the neck or back backwards, or develops a high-pitched cry or fever.4 These may be early warning signs of dangerously high levels of bilirubin that require prompt treatment to prevent a rare form of brain damage called kernicterus.
What is kernicterus?
Kernicterus is a type of brain damage caused by high levels of bilirubin. It can cause athetoid cerebral palsy characterized by uncontrollable tremors or writhing movements of the limbs, body and face), hearing loss, problems with vision and teeth and, sometimes, mental retardation.
No baby should develop kernicterus because there are effective treatments that can lower bilirubin levels before they become dangerous. While kernicterus is rare (the Centers for Disease Control and Prevention reported about 100 cases between 1984 and 2001)5, the number of affected children appears to be rising, possibly due in part to early hospital discharge of babies before jaundice is recognized or diagnosed.
How is jaundice treated?
Most babies with jaundice do not need treatment. Sometimes breastfeeding support is needed to increase bilirubin elimination through the gut. However, if a baby has moderate to severe jaundice that does not clear up on its own, phototherapy treatment may be recommended. The baby is placed naked (or wearing only a small diaper) under special white or blue lights called bili-lights. The baby wears shields to protect the eyes. The lights help change bilirubin in the blood to a form that can be easily eliminated in urine. Some babies are delayed in discharge from the newborn nursery or are admitted to the hospital for a few days for phototherapy, while others are treated at home. A baby's health care provider can discuss with the parents which treatment is appropriate for their baby. Phototherapy is safe. A few babies develop a mild skin rash that goes away when treatment is completed. Special fiber-optic blankets also can be used to treat some babies.
While phototherapy is effective, a few babies may not respond and continue to have rising or dangerously high bilirubin levels. They may need to be treated with an exchange transfusion. In this procedure, the baby's blood is removed little by little and replaced with donor blood. Exchange transfusion is effective at lowering bilirubin levels. However, it can pose a risk of infection and other complications, so it is recommended only when bilirubin levels are very high. It is best done in a neonatal intensive care unit.
Health care providers sometimes suggest steps parents can take at home to help clear up mild to moderate jaundice. The provider may recommend increasing the number of feedings to encourage more bowel movements, which helps eliminate bilirubin. For some breastfed babies, a pediatrician may recommend briefly (a day or two) stopping breastfeeding and feeding the baby formula. The mother can pump her milk to keep up her production.
Who is at increased risk of serious jaundice that requires treatment?
Some babies are at increased risk of serious jaundice, including1:
- Babies who have high bilirubin levels before leaving the hospital.
- Babies with signs of jaundice in the first 24 hours of life. A health care provider will carefully evaluate to see if there is an underlying disorder (such as a blood group incompatibility or genetic disease) contributing to the jaundice.
- Premature babies (born prior to 37 weeks of pregnancy).
- Babies who had a sibling who was treated for jaundice.
- Babies of East Asian descent.
- Breastfed babies, especially those who are not nursing well.
- Babies with large bruises or a cephalohematoma (bleeding under the scalp related to labor and delivery). Many red blood cells are broken down as these large bruises heal.
- Family history of a genetic disorder called G6PD deficiency.
Does the March of Dimes support research on newborn jaundice?
The March of Dimes has long supported research aimed at improving treatment of newborn jaundice. Basic research by one grantee in the 1980s led to the development of a drug called tin-mesoporphyrin that can help prevent jaundice in babies at high risk of serious jaundice. One study showed that the need for phototherapy was reduced by 76 percent among premature babies treated with the drug.5 This and related drugs may eventually reduce the length of hospital stays for jaundice treatment and make it possible to treat more babies at home.
In 2003, the March of Dimes co-sponsored a conference, along with the American Academy of Pediatrics, Centers for Disease Control and Prevention, and the National Institutes of Health, aimed at identifying areas where additional research is needed to improve the diagnosis and treatment of newborn jaundice.7 The March of Dimes also is collaborating with these and other health organizations in the Kernicterus Prevention Partnership, which aims to prevent all new cases of kernicterus in any full-term or near-term baby born in this country by 2006 by educating health care providers, as well as families, about the potential hazards of newborn jaundice.
Where can families get more information on kernicterus?
For additional information contact:
Parents of Infants and Children with Kernicterus (PICK)
One Superior Place, Suite 2410
Chicago IL 60610
(312) 274-9695
Visit the Web site of the U.S. Centers for Disease Control and Prevention:
Kernicterus
Where can families get information on Niemann-Pick disease?
Niemann-Pick disease (NPD) is a group of diseases that affect metabolism and that are caused by specific genetic mutations. One of the symptoms of NPD is jaundice following birth. The National Niemann-Pick Disease Foundation is a nonprofit organization that promotes research, provides information, and supports families of NPD patients.
8-04
|
|
|
| |
|
|
|
|
|
