This page discusses jaundice in the first month of life. If your older infant or child appears jaundiced, he or she should be evaluated by us.
Jaundice is a yellowish tinge of the skin and (occasionally) the "whites" of the eyes. Jaundice is caused by a rise in the amount of a substance called bilirubin in the bloodstream. Bilirubin is a by-product of the breakdown of red blood cells. Since old red blood cells are constantly being broken down, bilirubin is a substance that is always present in the bloodstream. Bilirubin levels are kept low by the liver, which metabolizes bilirubin and excretes it into the gut where it is subsequently eliminated in the stool.
All newborns have a transient rise in bilirubin before the level settles down to adult levels. There are several reasons for the rise. Red blood cells that are produced by a fetus are broken down more quickly compared to red cells produced after birth. The newborn's liver takes several days to begin processing bilirubin, since bilirubin prior to birth is eliminated through the placenta. Lastly, the newborn's bowel often moves sluggishly, resulting in reabsorption of bilirubin that has already been excreted by the liver.
Occasionally there are other factors that may exacerbate a rise in bilirubin. Bruising of the face and under the scalp ("cephalohematoma") that occurred from passage through the birth canal can result in a more rapid rate of blood cell breakdown. If the mother and infant have different blood types, antibodies that the mother naturally harbor against different blood types may find their way into the baby's bloodstream and cause the baby's blood cells to break down faster than usual.
Breast fed babies tend to have a higher bilirubin rise because breast milk is not produced for 48-72 hours after birth. The newborn does get colostrum, which contains antibodies and other proteins, but in much smaller amounts compared to the breast milk he or she will eventually receive. As a result, the newborn may not excrete bilirubin in the stool as rapidly. It is imprint for mothers to nurse frequently during the first several days of life to increase the breast milk supply, thus enabling the newborn to excrete bilirubin more rapidly. Jaundice is not a reason to discontinue breastfeeding.
Bilirubin levels generally peak by the fourth day of life and then decrease to normal levels by one week of life. While all infants have a rise in bilirubin levels, approximately half of infants will have a bilirubin level high enough to cause jaundice that is apparent on the skin. Jaundice is not dangerous except in very rare instances when the bilirubin level rises to very high levels. We check bilirubin levels if a newborn appears very jaundiced, and we also take contributing risk factors (e.g. blood type incompatibility, bruising, dehydration) into account. Treatment may consist of increasing fluid intake (e.g. supplementing with formula) and phototherapy, which consists of placing the infant under special fluorescent lights which will decrease the bilirubin level. Most phototherapy is done in the hospital, but sometimes it can be done at home.
How can you tell if your baby is jaundiced? Jaundice initially appears as a ruddy orange-yellow hue of the skin. Often the "whites" of the eyes appear yellow as well. A yellow hue is often seen in skin creases. Jaundice begins on the face and travels downward with higher bilirubin levels. If the yellowish color is limited to the face and upper trunk, the bilirubin level is not seriously elevated.
We should be notified if jaundice is present on the thighs and/or the "whites" of the eyes appear yellow. If lethargy or poor feeding is present we should be notified immediately.
Occasionally mild jaundice can be present in breast fed infants beyond a week. This is called "breast milk jaundice" and is different from the jaundice that is seen right after birth. Breast milk contains a factor that can transiently slow the liver's metabolism of bilirubin. Breast milk jaundice is always mild and never serious. It usually resolves after 3-4 weeks.
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