What is newborn jaundice?
The word jaundice actually means yellow. When someone says “your baby is jaundiced” or “your baby has jaundice”, they mean the same thing – “your baby looks yellow”. Babies become jaundiced when a chemical called bilirubin builds up in their bloodstream and body tissues, including the skin.
What is bilirubin?
Bilirubin is a waste-product of old red blood cells that the body no longer needs. Under normal circumstances, the liver filters the bilirubin from the blood and passes it to the bowel to be removed from the body in the bowel movements.
What causes the bilirubin to build up?
Some newborn babies produce bilirubin faster than their bodies can eliminate it. This can happen because…
- Early in life, newborn babies have to take their fetal red blood cells out of circulation and replace them with new, adult-type red cells. Disposing of the fetal red blood cells can load their bodies with a lot of bilirubin in a short amount of time.
- The body systems, especially the liver, that usually process bilirubin and change it into an easily disposable form are not very efficient in the newborn, especially if the baby is a few weeks premature.
- The only way for bilirubin to actually leave the body of a newborn is in the bowel movements. Babies who don’t nurse vigorously or often enough might not have enough bowel movements to eliminate the bilirubin from their bodies.
How long does jaundice last?
Newborn jaundice is usually gone by about 2 weeks of age. However, it should be “fading” after it peaks around the 4th or 5th day of life. Your baby should not still look as jaundiced at one week old as he or she did when 4 or 5 days old. If he is, you should call your doctor and ask for a bilirubin test, even if your baby already had one. The bilirubin level changes over time, and it could still be going up.
In some breastfed babies, the skin can continue to look a little bit yellow for up to 12 weeks. This is related to the breastmilk, and is normal as long as your baby is otherwise healthy and thriving (eating well, gaining weight, developing normally) but your pediatrician should evaluate your baby to make sure the bilirubin level is normal.
Does jaundice come back?
No. Newborn jaundice is limited to the newborn period and does not return.
Is jaundice harmful?
The amount of jaundice experienced by most newborns is not harmful. However, at very high levels, bilirubin is toxic (harmful, damaging) to the brain. When the bilirubin level in the blood rises very high or very fast, bilirubin starts to move from the bloodstream into the brain. In the brain, bilirubin can directly harm the brain cells, and actually cause permanent brain cell damage.
No one knows for certain how high the bilirubin has to get to cause brain damage, or how long it must remain high to cause brain damage. Therefore, if your baby has a high bilirubin level, it is important for him to be treated without delay.
How will I know if my baby has jaundice?
You may have noticed nurses and doctors in the hospital checking your baby for jaundice by pressing their fingers on your baby’s skin to check the color. This is the visual method of checking jaundice. Press lightly on the skin, as if you are checking a peach to see if it is ripe, and look at the color of the spot where your finger was. If it looks yellow (rather than white), that is jaundice.
The visual method is only used to decide which babies need a blood bilirubin test or a transcutaneous (“through-the-skin”) jaundice test. The visual method is not accurate for deciding how severe jaundice is. It must only be used under good daylight or fluorescent lighting conditions (next to a window is ideal). The baby should be undressed so different parts of the body (face, chest, abdomen, legs) can be compared.
Jaundice starts in the face and moves downward to the chest, then abdomen, then to the arms and legs as it gets more severe. However, this is NOT a safe way to monitor a baby’s bilirubin level. It is very important to have a qualified health professional evaluate your baby’s jaundice in person (not over the telephone) first.
What if my baby has darker skin?
It can be harder to see jaundice in darker skinned babies. Some parents will notice that their baby’s skin color is different, although they might use words such as tan rather than yellow to describe how it looks. Try pressing your finger on the baby’s gums to see the color after you lift your finger. If the spot where your finger was appears yellow, that is jaundice. Another good place to look is the white part of the baby’s eyes. If the white part of the eyes appears yellow, they are jaundiced and should see the doctor.
Does breastfeeding cause jaundice?
Jaundice is more common in babies who are breastfed. However, in the first week of life, it is not the breast milk that is causing jaundice in babies who are nursing, but insufficient breast milk. Some babies do not get enough breast milk in the first 3 or 4 days of life. If they don’t take in enough milk, they won’t have bowel movements, and if they don’t have bowel movements, their bodies won’t eliminate bilirubin. Your medical provider should be informed of nursing problems and can advise you or link you with people who can help.
Reasons that some nursing babies don’t take enough milk:
- Not feeding often enough. Breast fed babies need to nurse at least 8-12 times per day (every 2-3 hours). When possible, nurse the baby in a quiet room, away from noise and other activities and distractions so both you and the baby can relax and concentrate on the feeding.
- The baby is not latching on correctly, so your baby is sucking only on the nipple and not stimulating the flow of milk. This will make your baby frustrated at the breast. Your baby may suck vigorously for a while and then pull away and cry. If necessary, seek help to get your baby to latch on correctly; this is critical for your baby to get enough milk.
- Over-use of a pacifier. It is important that in these early days that you nurse the baby when your baby acts hungry, rather than using the pacifier. Later on, after your milk supply is well-established and the period of jaundice is over, you can re-introduce the pacifier if you feel your baby just needs to suck.
- The baby is sleepy or fussy at the breast, even after crying loudly before the feeding. It is important to respond to your baby’s hunger cues before your baby gets to the point of crying, whenever possible. Early signs of hunger are rooting (when the baby turns his or her head when touched as if looking for food) and sucking on pacifier or fingers. Babies put to the breast when they are in this state.
Why do some babies get jaundiced but not others?
Over 60% of newborns have some level of jaundice in the neonatal period. We don’t know for certain why some babies get jaundiced while others don’t, but there are some definite risk factors for jaundice. Babies that have one or more of these risk factors are more likely than other babies to become jaundiced:
- Babies born more than 2 weeks before their due date
- Babies who had a brother or sister who had jaundice
- Babies who are breastfeeding, especially if they aren’t taking to the breast very well
- Babies who have bruising or scalp hematomas from birth
- Babies of East Asian race