Infant Jaundice
Infant Jaundice is a yellow discoloration of a newborn baby’s skin and eyes. Infant jaundice occurs because the baby’s blood contains an excess of bilirubin, a yellow pigment of red blood cells.
Infant jaundice is a common condition, particularly in babies born before 38 weeks’ gestation (preterm babies) and some breastfed babies. Infant jaundice usually occurs because a baby’s liver isn’t mature enough to get rid of bilirubin in the bloodstream. In some babies, an underlying disease may cause infant jaundice.
Most infants born between 35 weeks’ gestation and full-term need no treatment for jaundice. Rarely, an unusually high blood level of bilirubin can place a newborn at risk of brain damage, particularly in the presence of certain risk factors for severe jaundice.
Infant Jaundice Symptoms
The most pervasive sign of infant jaundice is yellow skin and sclerae (the whites of the eyes). This typically starts at the head and spreads to the chest, stomach, arms, and then legs.
To check for infant jaundice, press gently on your baby’s forehead or nose. If the skin looks yellow where you pressed, it’s likely your baby has mild jaundice.
If your baby doesn’t have jaundice, the skin color should simply look slightly lighter than its normal color for a moment. Examine your baby in good lighting conditions, preferably in natural daylight.
when to see a doctor
Most hospitals have a policy of examining babies for jaundice before discharge. The American Academy of Pediatrics recommends that newborns be examined for jaundice during routine medical checks and at least every eight to 12 hours while in the hospital.
A baby should be examined for jaundice between the third and seventh days after birth when bilirubin levels usually peak. If your baby is discharged earlier than 72 hours after birth, make a follow-up appointment to look for jaundice within two days of discharge.
The following signs or symptoms may indicate severe jaundice or complications from excess bilirubin. Call your doctor if:
- Your baby’s skin becomes more yellow
- The skin on your baby’s the abdomen, arms or legs looks yellow
- The whites of your baby’s eyes look yellow
- Your baby seems listless or sick or is difficult to awaken
- Your baby isn’t gaining weight or is feeding poorly
- Your baby makes high-pitched cries
- Your baby develops any other signs or symptoms that concern you.
Infant Jaundice Causes
Excess bilirubin (hyperbilirubinemia) is the main cause of jaundice. Bilirubin, which is responsible for the yellow color of jaundice, is a normal part of the pigment released from the breakdown of “used” red blood cells.
Newborns produce more bilirubin than adults do because of greater production and faster breakdown of red blood cells in the first few days of life.
Normally, the liver filters bilirubin from the bloodstream and releases it into the intestinal tract. A newborn’s immature liver often can’t remove bilirubin quickly enough, causing an excess of bilirubin.
Jaundice due to these normal newborn conditions is called physiologic jaundice, and it typically appears on the second or third day of life.
Other Causes
An underlying disorder may cause infant jaundice. In these cases, jaundice often appears much earlier or much later than does the more common form of infant jaundice. Diseases or conditions that can cause jaundice include:
- Internal bleeding (hemorrhage)
- An infection in your baby’s blood (sepsis)
- Other viral or bacterial infections
- An incompatibility between the mother’s blood and the baby’s blood
- A liver malfunction
- An enzyme deficiency
- An abnormality of your baby’s red blood cells that causes them to break down rapidly
Infant Jaundice Risk Factors
Major risk factors for jaundice, particularly severe jaundice that can cause complications, include:
- Premature birth
A baby born before 38 weeks of gestation may not be able to process bilirubin as quickly as full-term babies do. Premature babies also may feed less and have fewer bowel movements, resulting in less bilirubin eliminated through the stool.
- Significant bruising during birth
Newborns who become bruised during delivery gets bruises from the delivery may have higher levels of bilirubin from the breakdown of more red blood cells.
- Blood type
If the mother’s blood type is different from her baby’s, the baby may have received antibodies through the placenta that cause abnormally rapid breakdown of red blood cells.
- Breast-feeding
Breast-fed babies, particularly those who have difficulty nursing or getting enough nutrition from breast-feeding, are at higher risk of jaundice. Dehydration or a low caloric intake may contribute to the onset of jaundice. However, because of the benefits of breast-feeding, experts still recommend it. It’s important to make sure your baby gets enough to eat and is adequately hydrated.
Infant Jaundice Complications
High levels of bilirubin that cause severe jaundice can result in serious complications if not treated. The following are some of the complications that are brought up by severe jaundice:
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Acute bilirubin encephalopathy
A condition caused by a build-up of bilirubin in the brain (bilirubin is toxic to brain cells). Signs of acute bilirubin encephalopathy in a baby with jaundice include fever, sluggishness, high-pitched crying, poor feeding, and arching of the body or neck. Immediate treatment may prevent further damage.
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Kernicterus
Kernicterus is the syndrome that occurs if acute bilirubin encephalopathy causes permanent damage to the brain. Kernicterus may result in:
- Involuntary and uncontrolled movements (athetoid cerebral palsy)
- Permanent upward gaze
- Hearing loss
- Improper development of tooth enamel
Infant Jaundice Diagnosis
Most hospitals discharge most mothers and newborns within 72 hours of delivery. It’s very important for parents to bring their babies in for a checkup a few days after birth because bilirubin levels peak between 3 to 7 days after birth.
The doctors will likely diagnose infant jaundice on the basis of the baby’s appearance. However, it’s still necessary to measure the level of bilirubin in the baby’s blood. The level of bilirubin (severity of jaundice) will determine the course of treatment.
Babies who develop jaundice in the first 24 hours of life should have bilirubin levels measured immediately, either through a skin test or blood test.
Tests to detect jaundice and measure bilirubin include:
- A physical exam
- A laboratory test of a sample of your baby’s blood
- A skin test with a device called a transcutaneous bilirubinometer, which measures the reflection of a special light shone through the skin.
Additional tests may be needed to see if a baby’s jaundice is due to an underlying condition. This may include testing your baby for their complete blood count (CBC), blood type, and Rhesus factor (Rh) incompatibility.
Infant Jaundice Prevention
There’s no real way to prevent newborn jaundice. During pregnancy, you can have your blood type tested.
After birth, your baby’s blood type will be tested, if necessary, to rule out the possibility of blood type incompatibility that can lead to newborn jaundice. If your baby does have jaundice, there are ways you can prevent it from becoming more severe:
- Make sure your baby is getting enough nutrition through breast milk. Feeding your baby 8 to 12 times a day for the first several days ensures that your baby isn’t dehydrated, which helps bilirubin pass through their body more quickly.
- If you’re not breastfeeding feeding your baby formula, give your baby 1 to 2 ounces of formula every 2 to 3 hours for the first week. Preterm or smaller babies may take smaller amounts of formula, as will babies who are also receiving breast milk. Talk to your doctor if you’re concerned your baby is taking too little or too much formula, or if they won’t wake to feed at least 8 times per 24 hours.
Carefully monitor your baby for the first five days of life for the symptoms of jaundice, such as yellowing of the skin and eyes. If you notice that your baby has the symptoms of jaundice, call your doctor immediately.
Infant Jaundice Treatment
Typically, treatment for mild jaundice in infants is unnecessary, as it tends to disappear on its own within 2 weeks. If the infant has severe jaundice, they may need to be readmitted to the hospital for treatment to lower levels of bilirubin in the bloodstream. In some less severe cases, treatment may be done at home.
Some treatment options for severe jaundice include:
- Phototherapy (light therapy)
Treatment by light rays. The baby is put under a special light, covered by a plastic shield to filter out ultraviolet light. The light manipulates the structure of bilirubin molecules so they can be excreted.
- Exchange blood transfusion
The baby’s blood is repeatedly withdrawn and then replaced (exchanged) with donor blood. This procedure will only be considered if phototherapy does not work because the baby would need to be in an intensive care unit (ICU) for newborns.
- Intravenous immunoglobulin (IVIg)
In cases of rhesus or ABO incompatibility, the infant may have a transfusion of immunoglobulin; this is a protein in the blood that lowers the levels of antibodies from the mother, which are attacking the infant’s red blood cells.
If jaundice is caused by something else, surgery or drug treatment may be required.