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Jaundice

More than half of all full-term babies and approximately four out of five premature babies develop jaundice shortly after birth and it is usually not a problem; however, it can be a sign of a serious disease, so it’s best to have your baby examined by a doctor and treated if necessary.

Jaundice is caused by excessive bilirubin, a byproduct of dying red blood cells, in the blood. We lose and replace about one percent of our red blood cells everyday, and the resulting bilirubin is processed through our liver and excreted in our stool. However, if too many red blood cells die at one time and there is too much bilirubin in the blood or the liver can’t dispose of it quickly enough, it builds up and causes the skin and whites of the eyes to turn yellow.Babies are generally born with more red blood cells than they need, the ordeal of birth can cause extra red blood cells to die (especially if forceps or a vacuum was used), and babies’ immature livers are unable to deal with the excess bilirubin.

There are two general types of jaundice: physiologic and pathologic. Physiologic jaundice is the normal type of jaundice seen in healthy babies and usually appears when a baby is two or three days old, peaks by day four, and subsides by day seven.

Breastfeeding jaundice occurs in the first week of life in more than 1 in 10 breastfed infants. It is thought this type of jaundice is caused by reduced amounts of breastmilk in the first days after birth because of infrequent feeding or inefficient feeding, leading to dehydration or low caloric intake. This is a type of physiologic jaundice.

Jaundice is called pathologic when it poses a risk to the baby, either because of its degree or its cause. Pathologic jaundice may arise for several reasons, including blood incompatibility, blood diseases, genetic syndromes, liver diseases, infections, medications, or physiologic jaundice that is heightened for some reason (such as prematurity, difficult delivery, or dehydration). Pathologic jaundice can appear earlier or later, rise faster, reach higher levels, last longer, and be accompanied by other symptoms, such as vomiting, dark urine, lethargy, too much weight loss, and abnormal body temperature.

When bilirubin reaches extremely high levels (more than 20 mg) it can lead to a rare but very serious condition called kernicterus, which can lead to deafness, severe developmental disabilities, and an unusual form of cerebral palsy. Jaundice can also cause problems for babies with certain risk factors, including:

• Babies who are born before 37 weeks

• Babies who weigh less than 2500 grams at birth

• Babies whose blood type is incompatible with their mothers’

• Babies who have an infection

• Babies who needed resuscitation at birth

Jaundice is usually diagnosed by physical examination. The doctor may gently press your baby’s skin to observe the coloring when the skin blanches. A specific diagnosis can be made by measuring bilirubin levels with a blood test. If you have already brought your baby home from the hospital, call your baby’s doctor immediately if you notice your baby’s arms or legs are jaundiced, he or she develops a fever above 100 degrees F (37.8 degrees C), or if he or she begins acting sick or listless. You should also call your doctor if the jaundice deepens after day 7, is not gone by day 15, or if your baby is not gaining sufficient weight.

Most cases of mild jaundice will subside on their own without special treatment. In these cases, feed your baby as frequently as possible to cause more bowel movements, which helps to remove the bilirubin from the body. Pathologic jaundice, on the other hand, is usually treated using phototherapy. This uses high intensity light of the right wavelength to convert the bilirubin pigment to a safer form that is easily removed from the body and does not build up to toxic levels. If severe jaundice develops because of blood type differences between you and your baby, intravenous immunoglobulin (IVIg) may be administered, which gives the baby an intravenous transfusion of antibodies. In extremely rare cases, your baby may need an exchange transfusion of blood which means small amounts of blood are repeatedly withdrawn, the bilirubin and maternal antibodies are “diluted out,” and the blood is transferred back to the baby.