Infant Jaundice

Infant jaundice is a yellow discoloration in a newborn baby’s skin and eyes. Infant jaundice occurs because the baby’s blood contains an excess of bilirubin (bil-ih-ROO-bin), a yellow-colored pigment of red blood cells.

Infant jaundice is a common condition, particularly in babies born before 38 weeks gestation (preterm babies) and some breast-fed babies. Infant jaundice usually occurs because a baby’s liver isn’t mature enough to get rid of bilirubin in the bloodstream. In some cases, an underlying disease may cause jaundice.

Treatment of infant jaundice often isn’t necessary, and most cases that need treatment respond well to noninvasive therapy. Although complications are rare, a high bilirubin level associated with severe infant jaundice or inadequately treated jaundice may cause brain damage.

Symptoms

Yellowing of the skin and the whites of the eyes is a sign of infant jaundice that usually appears between the second and fourth day after birth.

To check for infant jaundice, press gently on your baby’s forehead or nose. If the skin looks yellow where you pressed, it’s likely your baby has mild jaundice. If your baby doesn’t have jaundice, the skin color should simply look slightly lighter than its normal color for a moment.

Examine your baby in good lighting conditions, preferably in natural daylight.

When to see a doctor

Most hospitals have a policy of examining babies for jaundice before discharge. The American Academy of Pediatrics recommends that newborns be examined for jaundice during routine medical checks and at least every eight to 12 hours while in the hospital.

Your baby should be examined for jaundice between the third and seventh day after birth, when bilirubin levels usually peak. If your baby is discharged earlier than 72 hours following birth, make a follow-up appointment to look for jaundice within two days of discharge.

The following signs or symptoms may indicate severe jaundice or complications from excess bilirubin. Call your doctor if:

• Your baby’s skin becomes more yellow
• Your baby’s skin looks yellow on the abdomen, arms or legs
• The whites of your baby’s eyes look yellow
• Your baby seems listless or sick or is difficult to awaken
• Your baby isn’t gaining weight or is feeding poorly
• Your baby makes high-pitched cries
• Your baby develops any other signs or symptoms that concern you
• Jaundice lasts more than three weeks

Causes

Excess bilirubin (hyperbilirubinemia) is the main cause of jaundice. Bilirubin, which is responsible for the yellow color of jaundice, is a normal part of the pigment released from the breakdown of “used” red blood cells.

Normally, the liver filters bilirubin from the bloodstream and releases it into the intestinal tract. A newborn’s immature liver often can’t remove bilirubin quickly enough, causing an excess of bilirubin. Jaundice due to these normal newborn conditions is called physiologic jaundice, and it typically appears on the second or third day of life.

Other causes

An underlying disorder may cause jaundice. In these cases, jaundice often appears much earlier or much later than physiologic jaundice. Diseases or conditions that can cause jaundice include:

• Internal bleeding (hemorrhage)
• An infection in your baby’s blood (sepsis)
• Other viral or bacterial infections
• An incompatibility between the mother’s blood and the baby’s blood
• A liver malfunction
• An enzyme deficiency
• An abnormality of your baby’s red blood cells that causes them to break

Risk factors

Major risk factors for jaundice, particularly severe jaundice that can cause complications, include:

• Premature birth. A baby born before 38 weeks may not be able to process bilirubin as quickly as full-term babies do. Also, he or she may feed less and have fewer bowel movements, resulting in less bilirubin eliminated through stool.
• Significant bruising during birth. If your newborn gets bruises from the delivery, he or she may have a higher level of bilirubin from the breakdown of more red blood cells.
• Blood type. If the mother’s blood type is different from her baby’s, the baby may have received antibodies through the placenta that cause his or her blood cells to break down more quickly.
• Breast-feeding. Breast-fed babies, particularly those who have difficulty nursing or getting enough nutrition from breast-feeding, are at higher risk of jaundice. Dehydration or a low calorie intake may contribute to the onset of jaundice. However, because of the benefits of breast-feeding, experts still recommend it. It’s important to make sure your baby gets enough to eat and is adequately hydrated.

Complications

High levels of bilirubin that cause severe jaundice can result in serious complications if not treated.

Acute bilirubin encephalopathy

Bilirubin is toxic to cells of the brain. If a baby has severe jaundice, there’s a risk of bilirubin passing into the brain, a condition called acute bilirubin encephalopathy. Prompt treatment may prevent significant lasting damage.

The following may indicate acute bilirubin encephalopathy in a baby with jaundice:

• Listlessness or difficulty waking
• High-pitched crying
• Poor sucking or feeding
• Backward arching of the neck and body
• Fever
• Vomiting

Kernicterus

Kernicterus is the syndrome that occurs if acute bilirubin encephalopathy causes permanent damage to the brain. Kernicterus may result in:

• Involuntary and uncontrolled movements (athetoid cerebral palsy)
• Permanent upward gaze
• Hearing loss
• Improper development of tooth enamel