Some degree of jaundice occurs in a large majority of all newborn infants. Jaundice is a condition where a newborn baby’s skin turns yellow. This can happen with any race or colour of the skin.
Why Does Jaundice Occur So Frequently in Newborns?
Jaundice occurs when a chemical called bilirubin builds up in a baby’s blood. Everyone has bilirubin in their blood because it comes from our red blood cells. Our livers remove bilirubin from our blood for excretion in our urine and feces. Newborn babies have higher levels of bilirubin because their red blood cells have a higher turnover and a shorter life span. Before birth, the mother’s liver takes care of the excretion of her baby’s bilirubin. After birth, it takes the newborn’s liver some time to start doing it on its own.
Symptoms of Jaundice
The skin of a newborn baby will appear yellow. Sometimes the whites of the eyes turn a yellow colour as well. It commonly occurs between 1 and 4 days old.
The yellow colour usually starts on the face and then spreads to the chest, abdomen, arms and legs.
In babies with higher levels of bilirubin, they may be more tired and cranky. They may not feed as well if they are harder to wake up.
Is Jaundice Harmful for my Baby’s Health?
In most cases, jaundice is not harmful to your baby. It disappears when your baby’s body begins to excrete bilirubin on its own.
About 2% of infants will experience very high levels of bilirubin in their blood. This is called severe hyperbilirubinemia. Very high levels of bilirubin can affect brain cells, and can lead to seizures, deafness or brain damage. This is why newborns are assessed carefully for jaundice and treated to prevent high bilirubin levels.
Assessment of Bilirubin Levels
Nurses and physicians carefully assess babies for signs of jaundice prior to discharge from the hospital. They may use a skin or blood test to check your baby’s bilirubin level, especially if jaundice appears at less than 24 hours old.
To minimize blood tests, often a skin test is done using a trans-cutaneous bilirubinometer. The meter is placed on your baby’s forehead and uses a flash of light – this takes only a couple seconds and doesn’t hurt your baby at all. Sometimes blood tests are required depending on the situation.
Treatment of Jaundice
In majority of cases, jaundice goes away on its own and requires no treatment.
When bilirubin levels are high enough to necessitate treatment, the first line treatment is phototherapy. Phototherapy involves exposing your baby’s skin to a special blue light. The skin absorbs the light and helps your baby’s body convert the bilirubin into a form they can excrete in the urine and feces. This is usually done in hospital. Your baby’s eyes and genitals are protected during the light treatment. Phototherapy is a safe and effective way of reducing bilirubin levels.
You may have heard that exposing your baby to sunlight can help with jaundice. This can be harmful, and you should not do this without discussing with your physician first.
Prevention of Jaundice
The main way to decrease the risk of severe hyperbilirubinemia is to feed your baby often in the first hours and days after birth. This helps your baby pass more stool and provides adequate hydration and nourishment to your baby until the liver to starts eliminating bilirubin on its own. During this time, stools turn from dark green to yellow.
Breastfed babies can be at higher risk for elevated bilirubin levels if breastfeeding is not going well or if milk supply is not well established. In some cases, it may be helpful to supplement with formula until breastfeeding is well established.
When To Contact Your Doctor
After you return home post-delivery with your newborn, you should contact your doctor for any of the following:
- Your baby’s skin turns more yellow, or getting worse
- Your baby’s abdomen, arms or legs are yellow
- The whites of your baby’s eyes are yellow
- Your baby is jaundiced and hard to wake up, fussy, or not feeding well
- Your baby is jaundiced for more than 3 weeks
This post was co-authored by Erin Manchuk, BScPharm, BCGP and Stephanie Liu, MD, MSc, CCFP, BHSc.