Jaundice In Newborns

What is Jaundice?

Jaundice is a common condition in newborn babies.  It is usually not dangerous.  About 50% of full-term infants and 80% of premature infants have jaundice during the first week of life.  With this condition, the skin, and occasionally the whites of the eyes, will appear yellow or light orange.  This is due to your baby having increased amounts of a yellow substance in his blood called bilirubin.  The bilirubin in his bloodstream will cause his skin to appear yellow.

What is bilirubin?

Bilirubin is a natural substance formed in the body by infants, children, and adults.  It results from the normal breakdown of red blood cells.  Usually a mature liver is able to remove bilirubin as soon as it is formed, so most adults don't become jaundiced.

Why are newborns often jaundiced?

Babies are born with extra red blood cells which are broken down soon after birth.  The liver of a premature infant is especially immature, which is why infants born early become jaundiced more often than full-term infants.

When the bilirubin begins to build up in the blood, the infant starts to appear yellow.  The color change progresses from head to toe, so an infant with mild jaundice may appear yellow only on his face, while one with severe jaundice will be yellow over his entire body.

After being changed by the liver, most bilirubin is removed from the body through your baby's bowel movements.  Anything that increases the number of bowel movements (such as frequent feedings) will help get rid of the bilirubin.

When is jaundice a concern?

The level at which jaundice may be dangerous depends on many factors: your baby's age, whether he was full-term or premature, and whether he has any other medical conditions.  When the bilirubin level becomes too high, jaundice can be dangerous to your baby's developing nervous system.  This happens very rarely.  If your doctor is concerned that your baby may have serious jaundice, a very small sample of your baby's blood can be taken to measure the bilirubin to see if it is close to a dangerous level.

Jaundice and Breastfeeding

Early onset jaundice may be seen in the first week of life.  In breastfed babies it is very often caused by a baby not getting enough breast milk.  Because he is not drinking very much, his bowels are not moving, and the bilirubin cannot be removed from the body in the stools.  The best way to treat this is by breastfeeding more frequently (at least 8 times per day).  This will cause the bowels to move more often and remove the bilirubin from your baby's body.  Giving extra water will not help.  Early, frequent breastfeedings, even through the night, may help prevent early onset jaundice.

Late onset jaundice can be seen in the second and third week of life.  Bilirubin levels remain higher than normal, but almost never reach a dangerous level.  This is probably due to a substance in the breast milk that interferes with the removal of bilirubin.  Usually no treatment is necessary for this type of jaundice.  Occasionally, a mother may be asked to stop nursing for 1 or 2 days and use an alternative feeding.  It is important that a mother pump her breasts during this time so she can begin to breastfeed again as soon as the bilirubin level has fallen.

Checking for Jaundice and Treatment

How to check your baby for jaundice.

Remove all your baby's clothes and look at him in the natural light of a window.  Press your finger on his skin, and look at the color of his skin when you remove your finger, before his natural color returns.  If the color you see is yellow, he may be jaundiced.

How is jaundice treated?

For most babies, jaundice will go away by itself as the infant gets older and the body works better at removing the bilirubin.  If a blood test shows that the level of bilirubin is high, your baby's physician may order a treatment using special lights called phototherapy.  These lights change the make-up of bilirubin and will help his body get rid of it.  Phototherapy has been used for many years and is safe for infants.  It can be done in the hospital, or at home if the infant is well enough to be discharged from the hospital.

When to Call the Doctor or Nurse

Contact your baby's doctor or nurse if:

  • Your baby appears yellow during the first 2 days of life
  • Your baby is not feeding well or seems to be overly sleepy and sluggish
  • Your baby appears yellow over the arms and the legs
  • You are concerned about the increasing amount of yellow color of your baby's skin
  • Your baby has jaundice and it has not gone away 14 days after birth