A common condition in newborns, jaundice, can sometimes indicate a serious health problem.

What Causes Jaundice?

The yellow color of jaundice is caused by high levels of bilirubin in the blood, a substance that comes from the breakdown of red blood cells. The liver processes bilirubin, making it easier for the body to eliminate through urine and stool. Newborns have more red cells than older children and adults, and these new red cells don’t last as long, contributing to higher bilirubin levels. Additionally, newborn livers take some time to start effectively processing bilirubin, making jaundice common in the first few days of life.

Jaundice typically peaks within the first two to five days and lasts about one to two weeks. In breastfed babies, it can last longer, though this isn’t a cause for concern. Interestingly, bilirubin acts as an antioxidant and may help fight infection, so a little yellowness can be beneficial.

Rarely, Jaundice May Signal a Problem

In some cases, jaundice can indicate a problem, and high bilirubin levels can affect the brain permanently, a condition called kernicterus, which is very rare. Several conditions can increase the risk of high bilirubin levels, including:

– Dehydration or inadequate calories: Common in exclusively breastfed babies with unrecognized breastfeeding issues.

– ABO or Rh incompatibility: Differences in blood types between mother and baby can lead to more red cell breakdown.

– Premature birth: The liver may not be ready to process bilirubin.

– Infection or intestinal blockage: Jaundice would not typically be the only symptom.

– Bruising or cephalohematoma: Injuries during birth can lead to more red cell breakdown.

– Liver diseases: Various liver problems can hinder bilirubin elimination.

– Enzyme deficiencies: Diseases like G6PD deficiency or Gilbert syndrome affect enzyme function related to bilirubin.

– Genetic factors: Some genetic traits increase the risk of jaundice.

New Guidelines Recommendations

The new guidelines emphasize the importance of preventing and assessing jaundice. Here’s how doctors and parents can work together:

– Ensure the mother’s blood type and antibodies are checked, and the baby’s too if necessary.

– Assess all possible risks for jaundice, including family history, bruising, and early onset of jaundice.

– Use a device to check bilirubin levels at 24 to 48 hours of life, or sooner if the baby appears jaundiced or is going home early.

– Support breastfeeding mothers, as adequate feeding helps prevent jaundice.

– Schedule a follow-up appointment with the baby’s doctor, based on bilirubin levels and risk factors.

How Is Newborn Jaundice Treated?

Phototherapy is the most common treatment, where the baby is placed under a special light that helps eliminate bilirubin. This treatment is safe and effective. In extremely rare cases with very high bilirubin levels, an exchange transfusion may be necessary. Feeding also plays a crucial role in treatment, as frequent feeding helps the body eliminate bilirubin. Babies should wet at least six diapers and have regular stools, which should transition from black, tarry to lighter, seedy stools.

What Else Do Parents Need to Know About Newborn Jaundice?

Before leaving the hospital, parents should receive written information about jaundice, additionally, the baby’s bilirubin level, and instructions for follow-up care. Monitoring the baby’s jaundice at home is essential, especially in dark-skinned babies where jaundice can be harder to see. Pressing gently on the baby’s skin to check for yellowness can help.

Call the Doctor If Your Baby:

– Looks more yellow, especially if it extends below the knees

– Is feeding poorly or not wetting enough diapers

– Appears very sleepy and doesn’t wake to feed

– Is very fussy and hard to console

– Arches their head or back or acts strangely

– Has a fever or vomits frequently