Check out the PedsDocTalk YouTube Video: Newborn Jaundice for more information on jaundice as a newborn, including why newborns get jaundice, whether vaccines cause jaundice, do all babies get jaundice, why it’s treated, and common treatment strategies.
Do you know what newborn jaundice is? Have you looked back on baby pictures of your little one and noticed they looked slightly yellow in their early days? This yellowish discoloration of the skin and the white part of the eyes is called jaundice.
It’s most common in newborns but can also develop in older infants and children. It’s important to know what to look for if your infant appears jaundiced, how it’s often managed, and when to seek medical attention.
What is Jaundice?
Jaundice is the medical term for yellow discoloration of the skin and the white part of the eyes. It is caused by a buildup of bilirubin in the blood. Our body constantly makes new red blood cells and breaks down old ones. The spleen and liver break down red blood cells into different parts, including bilirubin. The bilirubin is then processed by the liver, secreted into bile, a fluid that aids in digestion, and is moved from the liver to the gallbladder, where it is stored until it is transported to the intestines. It is then removed from the body through stool and urine. A build-up of bilirubin causes a yellowish pigment or jaundice.
Almost all infants experience elevated bilirubin levels shortly after birth due to a combination of factors. Newborns have an immature liver that cannot process bilirubin as effectively. They also have a higher red blood cell breakdown rate, increasing bilirubin production. This jaundice is called “physiologic” jaundice because it happens due to the typical development of a newborn and resolves spontaneously. As the newborn’s liver develops and the red blood cell breakdown rate declines, bilirubin levels fall and return to normal. As those levels fall, jaundice disappears. So, you may hear clinicians say, “Jaundice level is normal” or, “Bilirubin level is normal,” as these terms are often used interchangeably, but remember, bilirubin is a lab that can be measured, and jaundice is a condition.
Do all babies get jaundice?
About 60% of all infants will show some degree of jaundice – yes, it’s very common!
So if your baby is dealing with this, know it is so common, and you are not alone! It’s not your fault. Every single baby is screened for jaundice, which is completed by drawing a bilirubin level.
There are several risk factors that make babies more likely to experience jaundice.
These include: prematurity, bruises from delivery and scalp hematomas from delivery, family history, blood type incompatibilities, and race.
You may have heard the myth that vaccines can cause jaundice. There is no evidence that this is true. This myth likely stemmed from the fact that many babies get the Hepatitis B vaccine in the hospital shortly after birth, and this is around the same time that jaundice typically presents. There is no evidence to show that babies who receive the hepatitis B vaccine after birth have increased rates of jaundice and it should definitely not be a reason to decline or postpone immunization.
What is physiologic versus pathologic jaundice?
Physiologic jaundice refers to the commonly expected jaundice as mentioned above. This type of jaundice is due to the immaturity of the baby’s biliary system. Pathologic jaundice refers to jaundice that is out of the ordinary. Both types of jaundice require further evaluation.
Physiologic jaundice appears after 24 hours of life, which is why labs are drawn routinely at 24 hours or 36 hours of life to confirm bilirubin levels that are not elevated. If the bilirubin levels were elevated, they are not rising rapidly between checks or from day to day.
Pathological jaundice appears within 24 hours of life, the rise is fast daily, and the child may have clay or white-colored stools.
Jaundice is monitored closely in the first two weeks of life after delivery. Additional monitoring is possible at the clinician’s office to determine if labs or additional interventions are required.
Will all jaundice resolve on its own?
With physiologic jaundice, the bilirubin levels typically peak about day 3-4 after birth and slowly fade and resolve on their own by 2-3 weeks. Hospitals typically will check your baby’s bilirubin levels between 24-48 hours after birth, either by testing their skin or blood levels.
This number will put them in a risk category, and that will determine how frequently they’ll want to check their levels. Infants who are low risk will not need any intervention and will likely not need their level rechecked.
The clinician may recommend phototherapy for infants at high risk. This is a treatment with a special ultraviolet light that is absorbed through the skin and helps transform the bilirubin into products that are easier to remove from the body. In the hospital, babies typically lay in a bassinet with a layer of UV lights suspended above them. Babies should be in minimal clothes, typically only a diaper when they’re receiving phototherapy to maximize exposed skin to help phototherapy be more effective. The baby can be removed from the bassinet for feedings and placed back in when done. If a baby is already discharged from the hospital, some clinicians will order a biliblanket to be used at home, which can reduce the need for light therapy for borderline high cases. Your clinician will advise you on the best treatment for your baby and how to use it.
Why it’s important to treat Jaundice?
You may be wondering why we need to treat jaundice if it will likely resolve on its own within a few days anyway? It is extremely important to monitor jaundice because if the bilirubin levels get too high, a rare but serious complication called kernicterus can occur. Kernicterus is caused by bilirubin accumulation in the brain resulting in damage to the brain or central nervous system. To prevent this, clinicians monitor bilirubin levels and use phototherapy to speed up the clearance of bilirubin if the level is getting closer to risky levels.
Sometimes, it can be difficult to see visually in darker-skinned babies, and every baby should get a level checked at 24-48 hours of life or if clinically indicated. Due to the availability of proper screening, we don’t see kernicterus in developed countries.
In severe cases of jaundice where the child is not responding to phototherapy, a baby may need to be transferred to the NICU for an exchange transfusion. This is a life-saving procedure to counteract the effects of serious jaundice or changes in the blood due to diseases such as sickle cell anemia. The procedure involves slowly removing the person’s blood and replacing it with fresh donor blood or plasma and it has no long-term consequences.
Do you have more questions about newborn jaundice?
For example, what about sunlight to treat jaundice? Does feeding my baby help with jaundice? Are there other kinds of jaundice? Breast milk versus breastfeeding jaundice?