Parent Teaching Sheet on Newborn Jaundice

What is newborn jaundice?

Jaundice refers to the yellow discoloration of the skin and the whites of the eyes. This condition occurs in about 60% of full-term infants and in about 80% of premature infants. This condition usually appears between 2 and 4 days of life. Most babies will require no special care of this jaundice. However, in severe cases, the jaundice can enter the baby's brain and could possibly cause damage.

What causes jaundice in newborns?

Jaundice occurs when a yellow pigment called billirubin builds up in the baby's blood. Red blood cells in our body die every day, this is a normal process. As these red blood cells die, they breakdown into a substance called billirubin. Normally, the liver removes billirubin from the blood and changes it into a form that can be passed from the body in the stool. In a newborn's first few days, the liver is immature and may not be able to adequately clear billirubin from the bloodstream. This is why jaundice happens in babies only in the first few days after delivery. A small number of breast-fed babies develop a form of jaundice called breast-milk jaundice. This type of jaundice progresses to higher levels and may last for several weeks. Certain health conditions in the baby may also contribute to jaundice.

Which baby is at increased risk for jaundice that requires treatment?

Babies with signs of jaundice in the first 24 hours of life
Premature babies
Babies who had a sibling treated for jaundice
Babies of East Asian, Mediterranean, American Indian, and African American descent
Pre-term and near-term infants (34-38 weeks) who are not breastfeeding well
Babies with infections
Babies with large bruises or a cephalohematoma (bruise on head from delivery)
Family history of a genetic disorder called G6PD deficiency
Babies released form the hospital prior to 48 hours of age, who do not receive recommended follow-up care within 2 or 3 days after release
Blood incompatibilities between mother and baby's blood types

What are the symptoms of jaundice?

The yellow discoloration of the skin usually first appears on the face. As the billirubin level increases, the yellow color will progress down the baby's body. A good way to see the yellow color is to gently press on the tip of the baby's nose or forehead with your fingertip. If the skin looks white or creamy, the baby probably does not have jaundice. If the skin looks yellow, the baby is probably jaundiced.

How is jaundice diagnosed?

Your baby's health care provider usually can diagnose jaundice by examining the baby. A provider also may do a blood test to confirm the severity of jaundice. Because jaundice levels usually peak at about 4 days of age, all babies who are discharged from the hospital before this time need to be assessed for the risk of developing serious jaundice between 4 and 7 days of age.

How is jaundice treated?

Most babies with jaundice do not require treatment. However, if a baby has moderate to severe jaundice that does not clear up on its own, phototherapy may be required. If a baby's level of jaundice is mild to moderate, the baby's health care provider may recommend increasing the number of feedings to encourage more bowel movements. In extreme cases, the baby's health care provider may also recommend stopping breastfeeding and feeding the baby formula for a day or two.

What is kernicterus?

Kernicterus is a type of brain damage that is caused by high levels of billirubin. Kernicterus can cause a type of cerebral palsy (this is a condition that causes uncontrollable tremors or writhing movements of the arms, legs, body, and face), hearing loss, problems with vision, dental problems, and mental retardation. Kernicterus is a rare condition, but the number of affected children does seem to be rising. Early hospital discharge may be partially to blame for this increase.

When should you call your baby's health care provider?

Parents should contact their baby's health care provider if their baby's skin looks yellow or if the baby's color is more yellow than the last time their baby was seen by their health care provider, if the baby's feeding becomes less vigorous, if the baby is sleeping more, or if the baby is not urinating and stooling normally.

Source: March of Dimes Article 681-9268, September 2003