Overview

What is jaundice in newborns?

Jaundice in newborns is when a baby's skin turns yellow. It happens because of a buildup of bilirubin in their blood. This condition is also called hyperbilirubinemia. Bilirubin is a yellow substance your body produces when red blood cells break down. During pregnancy, the mother’s liver takes care of removing bilirubin for the baby. However, after birth, your baby's liver takes over the job of removing bilirubin.

If your baby's liver isn't fully developed, it might struggle to eliminate bilirubin. When there's too much bilirubin in the body, your baby's skin may take on a yellowish hue.

Jaundice in infants is quite common and often not cause for alarm, typically resolving within a few weeks. However, your baby's healthcare provider must monitor them for jaundice. If severe jaundice is left untreated, it can potentially result in brain damage.

 What are the different types of newborn jaundice?

There are several variations of jaundice which can affect newborns.

1.     Physiological jaundice

The predominant form of jaundice seen in newborns is physiological jaundice, which is entirely normal. It typically appears in most infants by the second or third day after birth. Once your baby's liver matures, it will eliminate surplus bilirubin. Physiological jaundice is generally not a cause for concern and typically resolves without intervention within two weeks.

2.     Breastfeeding jaundice

Jaundice is more prevalent among breastfed infants compared to those fed with formula. Breastfeeding jaundice is also called Suboptimal Intake Jaundice often manifests within the first week of your baby's life, typically due to insufficient breast milk intake.  Breastfeeding jaundice may arise from challenges with nursing or delayed milk production. This type of jaundice might persist for a longer duration before resolving.

3.     Breast milk jaundice

Breast Milk Jaundice is also called Breastfeeding Failure jaundice and it is different from breastfeeding jaundice. This type of jaundice develops after one week of birth. This type of jaundice develops when your baby is not getting enough breast milk rather than the breast milk itself. This type of jaundice once developed may last for months or longer. 

Additionally, other forms of jaundice may develop if your baby has an unrelated medical condition.

How common is jaundice in newborns?

Jaundice in newborns is highly prevalent, with up to 60% of full-term infants experiencing it within their first week of life. Premature babies are even more susceptible, with as many as 80% developing jaundice during the same timeframe.

What are the signs and symptoms of jaundice in newborns?

The primary indicator of jaundice is the yellowing of your baby's skin, most notably visible in natural light, such as near a window. Typically, this yellowing initially appears on your baby's face. You may notice a yellowish tint in the whites of your baby's eyes and beneath their tongue. As the bilirubin levels rise, this yellowing might extend to your baby's chest, abdomen, arms, and legs. Detecting jaundice in babies with darker skin tones can be challenging. However, you can still observe for signs of jaundice by checking the color of their eyes and the area under their tongue.

Symptoms and Causes

What causes jaundice in newborns?

Jaundice occurs when there is an excess of bilirubin in your baby's blood. Bilirubin is a substance produced by the body during the breakdown of old red blood cells. In a typical scenario, your liver filters bilirubin from your bloodstream and your body eliminates it through bowel movements.

Some of the common causes of jaundice are, 

1. Severe jaundice may be a consequence of a blood infection, also known as sepsis.
2. Severe jaundice may result from having a different blood type than the mother.
3. Bruising due to a challenging delivery can lead to severe jaundice.
4. An excess of red blood cells can contribute to jaundice.
5. A liver condition like biliary atresia can be a factor in jaundice.
6. Jaundice may be due to Autoimmune disorders.
7. Jaundice can be due to hemolytic anemias. 
8. Jaundice can also be due to rare genetic metabolic defects in the body.

What are the symptoms of Jaundice?

Common symptoms of jaundice in newborns are,

1. Yellowish skin
2. Pain in the abdominal region
3. Brown color urine
4. Fever and chills

Diagnosis and Tests

How is jaundice in newborns diagnosed?

During your hospital stay, your baby's healthcare provider will examine for signs of jaundice. Typically, bilirubin levels peak when babies are three to five days old. Your baby's healthcare provider must re-evaluate them during this period. Your baby's healthcare provider can estimate their bilirubin level by using a probe placed on their head, which measures the transcutaneous bilirubin (TcB) level. If the TcB level is elevated, a blood test will be ordered to confirm the results.

The American Academy of Pediatrics utilizes a chart for newborn jaundice levels to assess the need for treatment. This chart considers your baby's total serum bilirubin level and age.

Management and Treatment

How is jaundice in newborns treated?

Treatment for jaundice in newborns is often unnecessary. Mild cases of jaundice typically resolve on their own as your baby's liver matures a process that may take one to two weeks. Frequent feeding (10 to 12 times a day) can promote bowel movements in your baby, aiding in the elimination of excess bilirubin from the body.

If your baby's bilirubin levels remain high or continue to increase, their healthcare provider might suggest phototherapy treatment. This involves exposing your baby to special blue lights while they are undressed. Phototherapy aids your baby's liver in eliminating excess bilirubin and is completely safe for them. Typically, phototherapy treatment lasts for one to two days. If your baby's bilirubin levels aren't excessively high, you may have the option to administer light therapy at home.

In rare instances where phototherapy proves ineffective, your baby's healthcare provider might suggest an exchange transfusion. During this procedure, a portion of your baby's blood is replaced with fresh, donated blood.

Prevention

How can I prevent jaundice in my newborn?

Jaundice in newborns is a common occurrence and typically cannot be prevented. However, you can lower the risk of your baby developing severe jaundice by ensuring frequent feedings. Regular feeding stimulates bowel movements, aiding in the elimination of bilirubin from your baby's body.

1. For breastfed babies, it's recommended to breastfeed your baby eight to 12 times a day during the first week after birth.
2. For formula-fed babies, it's advised to provide your baby with one to two ounces (30 to 60 milliliters) of formula milk every two to three hours during their first week after birth. Ensure at least eight feeds occur within 24 hours.

Additionally, ensure that your baby's healthcare provider examines their bilirubin level before discharge from the hospital.  Arrange a follow-up appointment within your baby's first week of life to reassess their bilirubin level.