Jaundice of the Newborn

Jaundice, technically known as hyperbilirubinemia, is seen quite commonly in newborn babies. It is the yellow color of the skin and whites of the eyes caused by excess bilirubin in the blood. Bilirubin is produced by the normal breakdown of red blood cells, which is collected and cleared by the liver. However, during the newborn period, the bilirubin accumulates in the blood temporarily at higher levels than usual. The reason for this accumulation is that the baby’s immature liver is overwhelmed by the breakdown of the red blood cells, which are higher in number in a newborn as compared with adults. So the bilirubin from broken down, excess baby red blood cells is an extra load that a newborn baby’s liver can’t handle. As a result, the blood bilirubin levels are higher. Referred to as physiological jaundice, this occurs in most newborns, usually by the second to the fourth day. It is mild and resolves on its own by the first or second week of age. In addition to the physiological or normal jaundice of the newborn, there are various conditions or situations that are associated with jaundice.

Jaundice in premature babies: Because premature babies’ livers are even more immature than full-term babies’ are, they have an even harder time clearing the excess bilirubin load at birth. As a result, babies born prematurely (at less than thirty-five weeks of pregnancy) are at higher risk for developing jaundice during the first few days of life.

Blood group mismatch: If a baby has a different blood type from his mother, the mother might produce antibodies that attack and break down the baby’s red blood cells. This adds to the bilirubin load on the baby’s liver and results in higher levels of jaundice. This is why the mother’s blood type is tested during pregnancy. If a mother’s blood type indicates a potential mismatch or incompatibility, there are some preventive measures that can be taken before a baby is born.

Breast milk jaundice: In a very small percentage of breastfed babies, certain substances in breast milk can cause the bilirubin level to rise.

Less common cases: In less common cases, jaundice may indicate another condition such as an infection, or even be prolonged or exaggerated by the presence of bruising or cephalohematomas (bruising of the head during childbirth).

Although in the vast majority of babies jaundice resolves on its own, levels of bilirubin higher than 25 milligrams per decilitre may cause deafness or brain damage. Because of the potential of these rare yet serious complications, all newborn babies are screened and examined for jaundice within a few days of birth.

If you notice your baby’s skin or eyes turning yellow or the color deepens or worsens, seek medical attention. Your healthcare provider will examine the baby and test for bilirubin. Testing for bilirubin levels involves a simple blood test.

Treating newborn jaundice

In most babies, jaundice will go away on its own. If your baby’s jaundice seems to be worsened by breastfeeding, speak to your healthcare provider to discuss options that are best suited for your situation.

If the bilirubin level is high, a baby will be tested regularly until the bilirubin starts to drop off to normal levels in the blood. In some cases, this may require readmission to the hospital. Some babies with high levels of jaundice, depending on their age and other circumstances, may require phototherapy or light therapy. This involves exposing a baby’s skin to special lights, which help speed up the clearance of the bilirubin from the blood. In rare cases, a blood exchange transfusion is used to remove the excess bilirubin from the baby’s blood.

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Pediatrician DR.PAUL Roumeliotis is certified by the American Board of Pediatrics and Royal College of Physicians and Surgeons of Canada. The information provided above is designed to be an educational aid only. It is not intended to replace the advice and care of your child’s physician, nor is it intended to be used for medical diagnosis or treatment. If you suspect that your child has a medical condition always consult a physician.