Newborn jaundice is a yellowing of a baby’s skin and eyes. Newborn jaundice is very common and can occur when babies have a high level of bilirubin, a yellow pigment produced during normal breakdown of red blood cells. In older babies and adults, the liver processes bilirubin, which then passes it through the intestinal tract. However, a newborn’s still-developing liver may not be mature enough to remove bilirubin.
The good news is that in most cases, newborn jaundice goes away on its own as a baby’s liver develops and as the baby begins to feed, which helps bilirubin pass through the body.
In most cases, jaundice will disappear within 2 to 3 weeks. Jaundice that persists longer than three weeks may be a symptom of an underlying condition. Additionally, high levels of bilirubin can put a baby at risk for deafness, cerebral palsy, or other forms of brain damage. That’s why the American Academy of Pediatrics (AAP) recommends that all newborn babies be examined for jaundice every time their vital signs are measured (or at least every 8 to 12 hours), before discharge from the hospital, and again a few days after discharge.
Risk factors and causes
Babies at highest risk for developing newborn jaundice are:
- premature babies, or babies born before 37 weeks’ gestation
- babies who aren’t getting enough breast milk (or formula, for babies that are not being given breast milk), either because they are having a hard time feeding or because their mother’s milk isn’t in yet
- babies whose blood type isn’t compatible with the blood type of their mother
A baby whose blood type isn’t compatible with that of their mother can develop a buildup of antibodies that can destroy their red blood cells and cause a sudden rise in bilirubin levels.
Other causes of newborn jaundice include:
- bruising at birth or other internal bleeding
- liver problems
- an infection
- an enzyme deficiency
- an abnormality in your baby’s red blood cells
The first sign of jaundice is a yellowing of a baby’s skin and eyes. The yellowing may begin within two to four days after birth and may start in the face before spreading down across the body. Bilirubin levels typically peak between 3 to 7 days after birth.
If a finger lightly pressed on a baby’s skin causes that area of skin to become yellow, it’s likely a sign of jaundice.
When to call a doctor
Most cases of jaundice are normal, but sometimes jaundice can indicate an underlying medical condition. Severe jaundice also increases the risk of bilirubin passing into the brain, which can cause permanent brain damage. Contact your doctor if you notice the following symptoms:
- the jaundice spreads or becomes more intense
- your baby develops a fever over 100°F (38°C)
- your baby’s yellow coloring deepens
- your baby feeds poorly, appears listless or lethargic, and makes high-pitched cries
The hospital discharges most mothers and newborns within 72 hours of delivery. It’s very important for parents to bring their babies in for a checkup a few days after birth, since bilirubin levels peak between 3 to 7 days after birth.
A distinct yellow coloring confirms that a baby has jaundice, but additional tests may be necessary to determine the severity of the jaundice.
Babies who develop jaundice in the first 24 hours of life should have bilirubin levels measured immediately, either through a skin test or blood test.
Additional tests may be necessary to see if a baby’s jaundice is due to an underlying condition. This may include testing your baby for their complete blood count (CBC), testing for their blood type, testing for Rhesus factor (Rh) incompatibility, and a Coombs test, which may be positive in cases of increased red blood cell breakdown.
Mild jaundice will usually resolve on its own as a baby’s liver begins to mature. Frequent feedings (between 8 to 12 times a day) will help babies pass bilirubin through their bodies.
More severe jaundice may require other treatments. Phototherapy is a common and highly effective method of treatment that uses light to break down bilirubin in your baby’s body. In phototherapy, your baby will be placed on a special bed under a blue spectrum light while wearing only a diaper and special protective goggles. A fiber-optic blanket may also be placed underneath your baby.
In very severe cases, an exchange transfusion may be necessary. In an exchange transfusion, a baby receives small amounts of blood from a donor or a blood bank. This replaces the baby’s damaged blood with healthy red blood cells. This also increases the baby’s red blood cell count and reduces bilirubin levels.
There’s no real way to prevent newborn jaundice. During pregnancy, you can have your blood type tested. After birth, your baby’s blood type will be tested if necessary to rule out the possibility of blood type incompatibility that can lead to newborn jaundice. If your baby does have jaundice, there are ways you can prevent it from becoming more severe.
- Make sure your baby is getting enough nutrition through breast milk. Feeding your baby 8 to 12 times a day for the first several days ensures that your baby isn’t dehydrated, which helps bilirubin pass through their body more quickly.
- If you’re unable to breastfeed and choose to feed your baby formula, give your baby 1 to 2 ounces of formula every 2 to 3 hours for the first week. Preterm or smaller babies may take smaller amounts of formula, as will babies who are also receiving breast milk. Talk to your doctor if you are concerned your baby is taking too little or too much formula or if they won’t wake to feed at least 8 times per 24 hours.
Carefully monitor your baby the first five days of life for the symptoms of jaundice, such as yellowing of the skin and eyes. If you notice that your baby has the symptoms of jaundice, call your doctor immediately.