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(Hyperbilirubinemia)

Definition

Jaundice is a yellow coloring in your baby’s skin, and sometimes, the whites of the eyes. Newborn jaundice happens during the first weeks of life.

Baby with Jaundice
Jaundice Baby
Copyright © Nucleus Medical Media, Inc.

Causes

The yellow coloring is caused by bilirubin. Bilirubin is a waste product. The body makes it when red blood cells are broken down. Bilirubin normally passes out of the body through feces or urine. Jaundice happens when there is a buildup of bilirubin. This can happen when:

  • The baby's body does not get rid of bilirubin in the first few days of life
  • The baby does not get enough breastmilk because the mother's milk is not in yet or the baby is having problems feeding
  • A substance in breast milk blocks bilirubin from leaving the body
  • There is a large breakdown of red blood cells due to things like a mismatch in blood types in the mother and baby
  • The baby has liver problems, such as infection or liver disease

Risk Factors

Newborn jaundice is more common in East Asian babies as well as babies who are very sick or born early. It is also more common in babies who have a sibling who was treated for jaundice. Other things that may raise the risk are:

  • High bilirubin levels or signs of jaundice in the first 24 hours of life
  • Poor feeding with breast
  • Baby has a different blood type than mother, resulting in hemolysis
  • Large bruises or bleeding under the scalp due to labor and delivery
  • Certain liver enzyme deficiencies

Symptoms

The main symptom of jaundice is yellow skin color. It often starts in the face and may spread to the stomach and legs.

Diagnosis

All babies are checked for jaundice at birth and at 3 to 5 days of age. The doctor will ask about your baby’s symptoms and health history. A physical exam will be done. It will focus on the baby's skin.

Tests may be:

  • Transcutaneous bilirubin (TcB)—a light is passed through the baby's skin to screen for high bilirubin levels
  • Blood test—to check level of bilirubin in blood

Treatment

Most babies will not need treatment. Jaundice often goes away in two to three weeks. Babies who do need treatment may need:

Extra Feedings

Increased breastfeeding can help clear bilirubin from a baby's body. Babies who are formula-fed will need to get extra formula.

Phototherapy

Phototherapy uses special lights to change the bilirubin in the blood. The bilirubin can then pass in the urine or stool.

Exchange Transfusion

Babies with severe jaundice may need a blood transfusion. This will replace the baby’s blood with new blood. The excess bilirubin will be removed with the blood.

Prevention

Newborn jaundice cannot always be prevented. The risk can be lowered by frequent feedings in the first several days after birth.

RESOURCES

Healthy Children—American Academy of Pediatrics  https://www.healthychildren.org 

March of Dimes  http://www.marchofdimes.org 

CANADIAN RESOURCES

Health Canada  https://www.canada.ca 

Public Health Agency of Canada  http://www.phac-aspc.gc.ca 

References

Infant jaundice. Family Doctor—American Academy of Family Physicians website. Available at: https://familydoctor.org/condition/infant-jaundice. Updated August 7, 2018. Accessed January 7, 2020.

Jaundice in healthy newborns. Kids Health—Nemours Foundation website. Available at: http://kidshealth.org/en/parents/jaundice.html. Updated April 2019. Accessed January 7, 2020.

Maisels MJ, Watchko JF, et al. An approach to the management of hyperbilirubinemia in the preterm infant less than 35 weeks of gestation. J Perinatol. 2012 Sep;32(9):660-664.

Neonatal cholestasis. EBSCO DynaMed website. Available at:  https://www.dynamed.com/condition/neonatal-cholestasis-18  . Updated March 14, 2017. Accessed September 21, 2017.

Neonatal hyperbilirubinemia. EBSCO DynaMed website. Available at:  https://www.dynamed.com/condition/neonatal-hyperbilirubinemia  . Updated September 23, 2019. Accessed January 7, 2020.

Neonatal hyperbilirubinemia. Merck Manual Professional Version website. Available at: http://www.merckmanuals.com/professional/pediatrics/metabolic%5Felectrolyte%5Fand%5Ftoxic%5Fdisorders%5Fin%5Fneonates/neonatal%5Fhyperbilirubinemia.html. Updated December 2018. Accessed January 7, 2020.

Revision Information

  • Reviewer: EBSCO Medical Review Board Kari Kassir, MD
  • Review Date: 09/2019
  • Update Date: 01/07/2020