New guidelines on newborn jaundice: What parents need to know - Harvard Health

A common condition in newborns occasionally signals a serious health problem.

Most newborn babies turn at least a little bit yellow. Known as jaundice, this condition is a very common and usually normal part of the newborn period. But in some very rare cases it can lead to, or be a sign of, a more serious problem. That's why parents need to know about it.

What causes jaundice?

The yellow color of newborn jaundice is caused by high levels of a substance called bilirubin in the blood. Bilirubin mostly comes from the breakdown of red blood cells. It gets processed in the liver to make it easier for the body to get rid of through the urine and stool.

Newborn livers need some time to get up and running when it comes to getting rid of bilirubin. Newborns also have more red cells than older children and adults, and those brand-new red cells don't last as long as red cells made as babies grow older. The combination of these two factors is what makes jaundice so common.

Jaundice usually peaks in the first two to five days of life, and lasts about one to two weeks. In babies who are breastfed, it can last longer; we don't know exactly why this happens, but it isn't anything to worry about.

Jaundice may actually protect babies, because bilirubin is an antioxidant that may help fight infection in newborn infants. This is another reason why parents shouldn't be too worried by a bit of yellowness: not only is it temporary, but it may also be helping their baby as he or she leaves the security of the womb.

Rarely, jaundice may signal a problem

Sometimes, though, jaundice can be a sign of another problem, and when bilirubin levels get very high it can affect the brain, sometimes in a permanent way. Called kernicterus, this is very, very rare, affecting far less than 1% of infants.

Many conditions make it more likely that bilirubin levels will be high, including:

• Dehydration or inadequate calories. This most commonly happens when babies are exclusively breastfed and a problem with breastfeeding goes unrecognized.
• ABO or Rh incompatibility. When mother and baby have differences in their blood types, it can lead to more breakdown of red cells than usual. Obstetricians are very aware of this issue, and all mothers should have blood tests to assess this risk.
• The systems that work to get rid of bilirubin may not be ready yet in babies who are born early.
• Infection, or a blockage of the intestine. Jaundice would not usually be the only symptom of this.
• Bruising or a cephalohematoma (a lump or a bruise on the head). Both can happen during a difficult birth. This leads to more red cells breaking down.
• Liver diseases. A number of different liver problems can make it harder for the baby's body to get rid of bilirubin.
• Diseases that affect an important enzyme. One common disease is glucose-6-phosphate dehydrogenase (G6PD) deficiency, which can cause red cells to break down. Other diseases, such as Gilbert syndrome or Crigler-Najjar syndrome, lead to a problem with an enzyme that is important for getting rid of bilirubin.
• Genetic factors. Not all of these factors are well understood. If one baby in a family has jaundice, future babies may have a higher risk too. Babies of East Asian descent, for example, are more likely to have higher bilirubin levels.

What do the new guidelines recommend?

The new guidelines stress the importance of preventing and assessing jaundice. Doctors and parents can work together to

• Make sure that the mother's blood type and antibodies have been checked. If there is a concern, the baby should be checked, too.
• Assess all possible risks for jaundice: not just the mother's blood type but also gestational age, family history, any bruising, how early jaundice appears, and other factors.
• Use a device to check bilirubin level at 24 to 48 hours of life, or sooner if a newborn looks jaundiced or is going home earlier.
• Make sure mothers get good support with feeding. When babies don't get enough to eat in the first three to five days of life, they have a higher risk of getting jaundice.
• Set up a follow-up appointment with the baby's doctor. The best timing for this depends on bilirubin level and risk factors. Parents, it's important to follow these instructions!

How is newborn jaundice treated?

The most common treatment is phototherapy. The baby is put under a special light (or wrapped in a special blanket with the light inside it) that helps the body get rid of bilirubin. This is safe and effective. When bilirubin levels are extremely high and there is concern for the possibility of brain damage, therapies such as exchange transfusion, where blood is taken out and new blood put back in, are necessary. However, this is extremely rare.

Feeding is an important part of therapy as well, because it helps the body get rid of bilirubin through the blood and urine. Feeding a newborn frequently also helps prevent problems with jaundice. Babies should wet at least six diapers over a 24-hour period, and should have stools regularly. The stool should change from the normal newborn black, tarry stools to stools that are lighter in color, looser, and "seedy."

What else do parents need to know about newborn jaundice?

Before going home, you should receive written information about jaundice, information about your baby's bilirubin level and other lab tests, and clear instructions about when the baby should see the pediatrician.

It's important to keep an eye on your baby's jaundice after you go home from the hospital. Jaundice can be harder to see in dark-skinned babies. A good way to look for it is to press down for a moment on the baby's skin in a spot where the bone is close (the forehead, nose, chest, or shin are good places to do this). This pushes out the blood briefly and should make the skin paler for a few seconds. If it looks yellow instead of pale, there may be jaundice.

Jaundice tends to spread from the face downward as bilirubin levels go up. For that reason, doctors worry far less about a baby who is yellow just in the face and upper chest than one who is yellow below the knees.

Call the doctor if your baby:

• is looking more yellow, especially if it is spreading down below the knees
• is feeding poorly, and/or isn't wetting at least six diapers in 24 hours and having regular stools
• is very sleepy, especially if they don't wake to feed
• is very fussy and hard to console
• arches their head or back, or is otherwise acting strangely
• has a fever or is vomiting frequently.

Remember: jaundice is common, and serious problems are rare! But call your doctor if you are worried; it's always better to be safe than sorry.

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