Jaundice and newborns

Newborn jaundice, also called neonatal jaundice, is a common newborn condition that develops when there's too much of a yellow pigment called bilirubin in the blood. Jaundice can cause the skin and whites of the eyes to turn yellow.


Causes/associated factors
Red blood cells carry oxygen throughout the body. When they die, they form bilirubin. Normally, bilirubin breaks down in the liver and leaves the body with the stool. If the level of bilirubin in a newborn's blood gets too high, he or she may develop jaundice.
Newborn jaundice is typically divided into three categories:

Physiologic jaundice occurs when the liver isn't developed enough to break down all the bilirubin. This type of jaundice typically appears on the second to fourth day of life.

Pathologic jaundice develops when an underlying disease increases bilirubin production or disrupts bilirubin removal. This may occur with diseases that destroy the red blood cells, such as Rh incompatibility. This type of jaundice often appears within the first 24 hours after birth or after the second week of life.

Rarely, breast milk jaundice may develop when a substance in breast milk interferes with bilirubin removal.
A newborn can also develop breastfeeding-associated jaundice, typically within the first week of life. This type of jaundice is usually due to inadequate or poor breastfeeding, such as when the mother's milk hasn't come in and the baby isn't getting enough nourishment.

Common risk factors that predispose a newborn to developing jaundice include:

race (Jaundice is more common for East Asian, Mediterranean and some Native American infants.)
prematurity
bruising at birth
inadequate feeding
infection
living in a high altitude
being male
having a sibling who had jaundice
having a mother who has diabetes

Signs/symptoms
Yellowing of the skin normally starts on the face when bilirubin levels are approximately 5 mg/dL and continues down the body, from head to toe, as the level of bilirubin increases. The whites of the eyes may also turn yellow. As the bilirubin level rises, your baby may sleep more and not feed as well.
To check for jaundice at home, bring your baby into good natural light and press your finger gently on his or her forehead or nose. Observe the color of the skin when you remove your finger. Normally, the skin will be white. When jaundice is present, the skin will be yellow. Call your baby's doctor if you suspect jaundice.


Diagnosis
The doctor will examine your baby, review your family medical history, and ask questions about your baby's health. The doctor may measure your baby's bilirubin level by testing a blood sample or touching a special monitor to your babyilirubin if it occurs in the first 24 hours after birth. With physiological jaundice, the bilirubin level often goes no higher than 15 mg/dl. Your baby's doctor may recommend no specific treatment and allow the jaundice to resolve on its own, which normally happens within two to three weeks.
If the level of bilirubin rises higher than 15 to 20 mg/dL, the doctor may recommend phototherapy with ultraviolet lights (called bili lights). Phototherapy alters the bilirubin, making it easier for the body to break down and eliminate the yellow pigment. This treatment can sometimes be done at home. For premature babies or those at high risk, phototherapy may begin at lower levels of bilirubin.

If your baby's bilirubin levels are very high (generally 20 to 25 mg/dL or higher), an exchange transfusion may be considered. With this procedure, the baby's blood is replaced with fresh blood that contains very little bilirubin. The decision to use this procedure depends on your baby's age, the level of bilirubin, and what's causing the problem. Sometimes, exchange transfusions and phototherapy are used together.


Complications
Rarely, a high bilirubin level can cause brain damage. This condition, called kernicterus, is most common in very premature and critically ill newborns. Kernicterus can lead to neurological damage, deafness or mental deficiency. In some cases, it can be fatal. The symptoms may include:
extreme sleepiness and difficulty awakening
weakness or limpness
poor sucking or feeding
high-pitched cries
arched posture with the head and feet bent backward

Prevention
Premature babies have a higher risk of developing newborn jaundice, so it's best to take steps to prevent premature labor. For example, don't smoke or drink while you're pregnant, gain an adequate amount of weight, eat healthfully (including taking recommended vitamin supplements), and follow any activity precautions your doctor may have given you.
After your baby is born, good feedings are essential. Feeding your baby soon after birth can increase intestinal movement and excretion, which will help prevent indirect bilirubin accumulation. If you're breastfeeding, nurse your baby every two to three hours around the clock, and take note of how well the baby nurses. You may want to consult a lactation specialist for additional support and instruction.

Also, count your baby's bowel movements and wet diapers. After the first three days, you can expect a breastfed baby to have three to four stools, five to six wet disposable diapers, or six to eight wet cloth diapers a day. Whether you're breastfeeding or using formula, call the doctor if your baby isn't urinating or having bowel movements this often, appears jaundiced or simply isn't feeding well.

Be sure to make an appointment for your baby's first checkup as well, typically recommended three to five days after birth. The doctor will check your baby for jaundice during this appointment.