Overview Of Jaundice In Newborns (Hyperbilirubinemia)
Newborn jaundice occurs when a baby has a high level of bilirubin in the blood. Bilirubin is a yellow substance that the body creates when it replaces old red blood cells. The liver helps break down the substance so it can be removed from the body in the stool.
A high level of bilirubin makes a baby’s skin and the whites of the eyes look yellow. This is called jaundice.
Commonly Associated With
Jaundice of the newborn; Neonatal hyperbilirubinemia; Bili lights – jaundice; Infant – yellow skin; Newborn – yellow skin
Causes Of Jaundice In Newborns (Hyperbilirubinemia)
It is normal for a baby’s bilirubin level to be a bit high after birth.
When the baby is growing in the mother’s womb, the placenta removes bilirubin from the baby’s body. The placenta is the organ that grows during pregnancy to feed the baby. After birth, the baby’s liver starts doing this job. It may take some time for the baby’s liver to be able to do this efficiently.
Most newborns have some yellowing of the skin or jaundice. This is called physiological jaundice. It is usually noticeable when the baby is 2 to 4 days old. Most of the time, it does not cause problems and goes away within 2 weeks.
Two types of jaundice may occur in newborns who are breastfed. Both types are usually harmless.
Breastfeeding jaundice is seen in breastfed babies during the first week of life. It is more likely to occur when babies do not nurse well or the mother’s milk is slow to come, leading to dehydration.
Breast milk jaundice may appear in some healthy, breastfed babies after day 7 of life. It is likely to peak during weeks 2 and 3 but may last at low levels for a month or more. The problem may be due to how substances in breast milk affect the breakdown of bilirubin in the liver. Breast milk jaundice is different than breastfeeding jaundice.
Severe newborn jaundice may occur if the baby has a condition that increases the number of red blood cells that need to be replaced in the body, such as:
- Abnormal blood cell shapes (such as sickle cell anemia)
- Blood type mismatch between the mother and baby (Rh incompatibility or ABO incompatibility)
- Bleeding underneath the scalp (cephalohematoma) caused by a difficult delivery
- Higher levels of red blood cells, which is more common in small-for-gestational-age (SGA) babies and some twins
- Infection
- Lack of certain important proteins, called enzymes
Things that make it harder for the baby’s body to remove bilirubin may also lead to more severe jaundice, including:
- Certain medicines
- Infections present at birth, such as rubella, syphilis, and others
- Diseases that affect the liver or biliary tracts, such as cystic fibrosis or hepatitis
- Low oxygen level (hypoxia)
- Infections (sepsis)
- Many different genetic or inherited disorders
- Babies who are born too early (premature) are more likely to develop jaundice than full-term babies.
Symptoms Of Jaundice In Newborns (Hyperbilirubinemia)
Jaundice causes a yellow color of the skin. It usually begins on the face and then moves down to the chest, belly area, legs, and soles of the feet.
Sometimes, infants with severe jaundice may be very tired and feed poorly.
Exams & Tests
Health care providers will watch for signs of jaundice at the hospital. After the newborn goes home, family members will usually spot jaundice.
Any infant who appears jaundiced should have bilirubin levels measured right away. This can be done with a blood test.
Many hospitals check total bilirubin levels on all babies at about 24 hours of age. Hospitals use probes that can estimate the bilirubin level just by touching the skin. High readings need to be confirmed with blood tests.
Tests that will likely be done include:
- Complete blood count
- Coombs test
- Reticulocyte count
Further testing may be needed for babies who need treatment or whose total bilirubin level is rising more quickly than expected.
Treatment Of Jaundice In Newborns (Hyperbilirubinemia)
Treatment is not needed most of the time.
When treatment is needed, the type will depend on:
- The baby’s bilirubin level
- How fast the level has been rising
- Whether the baby was born early (babies born early are more likely to be treated at lower bilirubin levels)
- How old the baby is
- A baby will need treatment if the bilirubin level is too high or is rising too quickly.
A newborn baby with jaundice needs to take in plenty of fluids with breast milk or formula:
- Feed the baby often (up to 12 times a day) to encourage frequent bowel movements. This helps removes bilirubin through the stools. Ask your provider before giving your newborn extra formula.
- In rare cases, a baby may receive extra fluids by IV.
Some newborns need to be treated before they leave the hospital. Others may need to go back to the hospital when they are a few days old. Treatment in the hospital usually lasts 1 to 2 days.
Sometimes, special blue lights are used on infants whose levels are very high. These lights work by helping to break down bilirubin in the skin. This is called phototherapy.
- The newborn with jaundice is placed under these lights in a warm, enclosed bed to maintain a constant temperature.
- The baby will wear only a diaper and special eye shades to protect the eyes.
- Breastfeeding should be continued during phototherapy, if possible.
- In rare cases, the baby may need an intravenous (IV) line to deliver fluids.
- If the bilirubin level is not too high or is not rising quickly, you can do phototherapy at home with a fiberoptic blanket, which has tiny bright lights in it. You may also use a bed that shines light up from the mattress.
- You must keep the light therapy on your child’s skin and feed your child every 2 to 3 hours (10 to 12 times a day).
- A nurse will come to your home to teach you how to use the blanket or bed, and to check on your child.
- The nurse will return daily to check your child’s weight, feedings, skin, and bilirubin level.
- You will be asked to count the number of wet and dirty diapers.
In the most severe cases of jaundice, an exchange transfusion is required. In this procedure, the baby’s blood is replaced with fresh blood. Giving intravenous immunoglobulin to babies who have severe jaundice may also be effective in reducing bilirubin levels.