Clinical Reference Systems: Pediatric Advisor 10.0
Jaundice of the Newborn
In jaundice the skin and the whites of the eyes (the sclera)
are yellow because of increased amounts of a yellow pigment
called bilirubin in the body. Bilirubin is produced by the
normal breakdown of red blood cells. Bilirubin accumulates
if the liver doesn't excrete it into the intestines at a
CAUSES OF JAUNDICE IN NEWBORNS
- Physiological (normal) jaundice
Physiological jaundice occurs in more than 50% of
babies. An immaturity of the liver leads to a slower
processing of bilirubin. The jaundice first appears at
2 to 3 days of age. It usually disappears by 1 to
2 weeks of age, and the levels of bilirubin are
- Breast-feeding jaundice
Breast-feeding jaundice may occur when your baby does
not drink enough breast milk. It occurs in 5% to 10% of
newborns. The jaundice symptoms are similar to those of
physiological jaundice, just more pronounced. The
jaundice indicates a need for help with breast-feeding.
- Breast-milk jaundice
Breast-milk jaundice occurs in 1% to 2% of breast-fed
babies. It is caused by a special substance (inhibitor)
that some mothers produce in their milk. This substance
(an enzyme) causes your baby's intestine to absorb more
bilirubin back into his body than normal. This type of
jaundice starts at 4 to 7 days of age. It may last 3 to
10 weeks. It is not harmful.
- Blood group incompatibility (Rh or ABO problems)
If a baby and mother have different blood types,
sometimes the mother produces antibodies that destroy
the newborn's red blood cells. This causes a sudden
buildup of bilirubin in the baby's blood. This serious
type of jaundice usually begins during the first
24 hours of life. Rh problems formerly caused the most
severe form of jaundice. However, they are now
preventable if the mother is given an injection of
RhoGAM within 72 hours after delivery. This prevents
her from forming antibodies that might endanger other
babies she has in the future.
- Physiological (normal) jaundice (bottle-fed newborns)
If you feed your baby with a bottle, feed your baby more
often. Try to feed your baby every 2 to 3 hours during
- Breast-feeding jaundice
The main treatment is to increase the supply of breast
milk. Read about breast-feeding or talk with a
lactation specialist. Nurse your baby more often.
Nurse your baby every 1-and-1/2 to 2-and-1/2 hours.
Since the bilirubin is carried out of the body in the
stools, passing frequent bowel movements (BMs) is
helpful. If your baby sleeps more than 4 hours at
night, awaken him for a feeding. Frequent weight checks
are also important. If you must supplement, use
formula, not glucose water.
- Breast-milk jaundice
Occasionally the bilirubin will not come down with
frequent feedings. In this situation the bilirubin
level can be reduced by alternating each breast-feeding
with formula feeding for two or three days.
Supplementing with glucose water is not as helpful as
formula for moving the bilirubin out of the body.
Whenever you miss a nursing, be sure to use a breast
pump to keep your milk production flowing.
Breast-feeding should never be permanently discontinued
because of breast milk jaundice. Once the jaundice
clears, you can return to full breast-feeding and you
needn't worry about the jaundice coming back.
- Severe jaundice (blood group incompatibility)
High levels of bilirubin (usually above 20 mg/dl) can
cause deafness, cerebral palsy, or brain damage in some
babies. High levels usually occur with blood type
differences. These complications can be prevented by
lowering the bilirubin using phototherapy (blue light
that breaks down bilirubin in the skin). In many
communities, phototherapy can be used in the home.
In rare cases where the bilirubin reaches dangerous
levels, an exchange transfusion may be used. This
technique replaces the baby's blood with fresh blood.
Physiological jaundice does not rise to levels requiring
this type of treatment.
CHECKING FOR JAUNDICE
Newborns often leave the hospital within 24 to 48 hours of
their birth. Parents therefore have the responsibility to
closely observe the degree of jaundice in their newborn.
The amount of yellowness is best judged by viewing your baby
unclothed in natural light by a window.
CALL YOUR CHILD'S PHYSICIAN IMMEDIATELY IF:
- You observe any signs of dehydration.
- Jaundice is noticed during the first 24 hours of life.
- Your baby develops a fever over 100.4ƒF (38ƒC).
- Your baby also starts to look or act sick.
CALL YOUR CHILD'S PHYSICIAN DURING OFFICE HOURS IF:
- Your baby looks deep yellow or orange.
- Your baby is not getting enough milk or gaining weight
- Your baby has less than three good-sized BMs per day.
- Your baby has less than six wet diapers per day.
- The jaundice is not gone by day 14.
- You have other questions or concerns.