Sick baby care
Skin usually starts to turn yellow a few days after birth. In most cases, jaundice goes away without treatment and does not harm the baby or cause any discomfort. However, babies with severe jaundice can have high bilirubin levels, which can pose a risk of brain damage.
The American Academy of Pediatrics (AAP) recommends that all babies be checked for jaundice before they leave the hospital (3, 4). Babies should be examined again by a health care provider at 3 to 5 days of age because this is the time when bilirubin levels are highest (3, 4). When necessary, a baby can be treated to prevent bilirubin levels from getting too high.
How are babies checked for jaundice?
A health care provider examines 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 sensor or a blood test. The blood test is the most accurate way to determine the level of bilirubin. Providers may recommend one of these tests 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 the newborn period, 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, causing bilirubin to build 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 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 (3).
Certain health problems in the baby 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. Babies with these conditions 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 (3). However, jaundice occurs mainly in babies who are not nursing well (3, 4). These babies may not get enough calories and may become dehydrated, both of which may contribute to jaundice. Breastfeeding mothers should nurse their babies at least 8 to 12 times a day for the first several days of life to help keep their baby’s bilirubin level down (4).
The AAP recommends that all healthy full-term and near-term babies be breastfed (4). Breast milk is the ideal food for babies and provides many health benefits, including reducing the risk of infections.
What are the signs of jaundice?
Yellow discoloration usually first appears on the face and in the whites of the eyes. 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 a parent thinks there is a yellowish color, he should contact the baby's health care provider.
Most babies with jaundice 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 a baby with jaundice (1, 4):
- Appears very yellow
- Is hard to wake
- Sucks or nurses poorly
- Appears floppy or stiff (or alternates between both)
- Arches the neck or back backwards
- Develops a high-pitched cry or fever
- Has unusual eye movements
These may be 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, sometimes, intellectual disabilities.
No baby should develop kernicterus because there are effective treatments that can lower bilirubin levels before they become dangerous. While kernicterus is rare, the exact incidence in the United States is unknown. About 125 babies with kernicterus were reported to a kernicterus registry from 1984-2002 (5). The number of affected children may 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. 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.
However, if a baby has moderate to severe jaundice that does not clear up on its own, treatment is recommended:
Phototherapy: The baby, wearing only a small diaper, is placed 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 receive phototherapy before 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.
Exchange transfusions: Babies who do not respond to phototherapy and continue to have rising or dangerously high bilirubin levels may need to be treated with a special kind of blood 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 done in a newborn intensive care unit.
Who is at increased risk for serious jaundice that requires treatment?
Some babies are at increased risk for serious jaundice, including (3, 4):
- Babies with signs of jaundice in the first 24 hours of life. A health care provider can check to see if the baby has an underlying disorder (such as a blood-group incompatibility or genetic disease) contributing to the jaundice.
- Premature babies (born before 37 completed weeks of pregnancy)
- Babies who have a sibling who was treated for jaundice
- Babies of East Asian descent
- Babies who have high bilirubin levels before leaving the hospital
- 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)
- 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 prevention and treatment of newborn jaundice. In 2003, the March of Dimes cosponsored a conference with the AAP, the Centers for Disease Control and Prevention (CDC) and the National Institutes of Health, aimed at identifying areas where research is needed to improve the diagnosis and treatment of newborn jaundice (6).
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 educating health care providers, as well as families, about the potential hazards of newborn jaundice.
Where can families get more information on jaundice and kernicterus?
For additional information, contact:
- American Academy of Pediatrics (AAP)
- Centers for Disease Control and Prevention
- Parents of Infants and Children with Kernicterus (PICK), (312) 274-9695
- Centers for Disease Control and Prevention (CDC). Frequently Asked Questions about Jaundice and Kernicterus. Updated 3/28/07.
- Maisels, M.J. and McDonagh, A.F. Phototherapy for Neonatal Jaundice. New England Journal of Medicine, volume 358, number 9, February 28, 2008, pages 920-928.
- American Academy of Pediatrics (AAP). Questions and Answers: Jaundice and Your Newborn. Posted 6/25/04, accessed 4/21/08.
- American Academy of Pediatrics (AAP). Management of Hyperbilirubinemia in the Newborn Infant 35 or More Weeks of Gestation: Clinical Practice Guideline. Pediatrics, volume 114, number 1, July 2004, pages 297-316.
- Springer, S.C. Kernicterus. EMedicine, updated 7/31/06.
- Blackmon, L.R., et al. Research on Prevention of Bilirubin-Induced Brain Injury and Kernicterus: National Institute of Child Health and Human Development Conference Summary. Pediatrics, volume 114, number 1, July 2004, pages 229-233.