Many mothers who give birth to full term healthy babies remember jaundice as the first disease their child ever had. While it is a fairly harmless and common occurrence – 60% of healthy term infants get it – it is still important to understand the condition so that you neither go through unnecessary panic nor miss any severe (albeit rare) symptoms.
What Is Infant Jaundice?
The most important and frequent medical term you will hear if your baby has jaundice is Bilirubin. Bilirubin is a yellow colored substance resulting due to the normal breakdown of red blood cells. It is present in all our bodies. It normally leaves the body through urine and stool.
Jaundice occurs when your baby’s body cannot get rid of bilirubin like we adults do. This is mainly because the baby’s liver – the organ that breaks down bilirubin – is not yet completely developed in the initial days. This is why it is common for baby’s bilirubin level to spike after birth (when he/she was inside you, your placenta did the job for it).
Bilirubin Levels in Newborns
97% of term babies have serum bilirubin values <13 mg/dl, and all infants with a serum bilirubin level >13 mg/dl require a minimum work up. Other criteria of non-physiologic jaundice are visible jaundice on the first day of life, a total serum bilirubin level increasing by more than 5 mg/dl per day, a direct serum bilirubin level exceeding 1.5 mg/dl, and clinical jaundice persisting for more than 1 week in term babies (may persist longer in breast-fed infants. Source: Management of Hyperbilirubinemia in the Newborn Period by John A. Widness, MD.
Types of Jaundice in New Born Babies
- Physiological Jaundice:
- Why: This is the most common type of jaundice and occurs because the babies’ organs are still maturing and can’t get rid of excess bilirubin efficiently.
- When: It starts about 24 hours after birth, peaks on 3rd or 4th day, and goes away in 1-2 weeks.
- Breastfeeding Jaundice:
- Why: This occurs when babies do not get enough breast milk – either because they have difficulty taking in milk or because the mothers’ milk hasn’t come down yet. This causes the concentration of bilirubin in the blood to rise.
- When: It starts after 48-72 hours and usually subside when your baby starts getting enough milk.
- Breast Milk Jaundice:
- Why: This occurs when certain substances in the breast milk interferes with the babies liver functionality, resulting in bilirubin level to rise. This is a rare condition– only 1-2% of babies get it.
- When: Your infant is vulnerable to breast-milk jaundice after the first 3 to 5 days. This condition gradually improves over 3 to 12 weeks.
- Incompatibility Jaundice:
- Why: Blood type incompatibility between the mother and the baby result is what is called as Blood group incompatibility jaundice. Essentially, it translates into a condition when an infant’s red blood cells get destroyed by some antibodies produced by the mother’ body. This can increase the bilirubin level rapidly.
- When: This starts within the first 24 hours of the baby’s life. However, in order to prevent this, the mother is given Rh immune-globulin injections.
These are the most commonly seen jaundices in healthy newborn babies. If the baby is born premature, it is always assumed that their bodies are not mature enough to excrete bilirubin and hence given treatment.
As is evident from the section above, in many cases jaundice peaks after 3 days – when you are most likely home after being discharged from the hospital. Hence it is important to understand different symptoms on your baby.
Symptoms Of Newborn Jaundice
Infant jaundice shows up its symptoms on the second or fourth day after birth. You will observe that the baby’s skin color has changed to yellow and the eyes appear white. Yellow color is generally observed first on the face and then it appears to move down to the chest, belly area, legs, and feet.Your baby may also appear tired and fatigued and will not feed properly. A baby will also cry loudly and appear sick, and it will be seen that he does not like waking up.
Treatment of Neonatal Jaundice
Your baby’s pediatrician would most likely examine the baby for jaundice before discharge. Even if your baby’s bilirubin level was normal, your doctor would suggest a follow-up visit on the baby’s fifth day of life. Make sure to ask your doctor about follow up check ups.
You can also check for it at home. Place the baby in a naturally well-lit room and check for yellowish skin. Even if you cannot spot any right away, try pressing the skin on different parts of baby’s face and look for yellowish tint as you lift your finger. Also, check for yellowness in the gums or the whites of the baby’s eyes. Treatment is not needed most of the time. But when it is needed, the type of the treatment will depend on:
- The baby’s bilirubin level
- How fast the level has been rising
- How old the baby is
In most cases phototherapy is effective (placing a baby in a crib or cradle wearing just diaper, with his/her eyes covered, under blue lights). Most of our parents advise us to expose the baby to indirect sunlight. Both these techniques are based on same principle – ultraviolet light changes the bilirubin to a form that the baby can more easily dispose of in his urine. The former is just faster and more concentrated.
For both physiological jaundice and breastfeeding jaundice, what you can do your own is to ensure your baby is always well-hydrated, either with breast milk or with formula, so he/she will pass urine and stool more often.
For breast milk jaundice, the doctor might recommend you not to breastfeed the baby for couple of days to bring the bilirubin level down.
In severe cases where phototherapy does not give results, the baby may need to be admitted to the ICU for a blood transfusion called an “exchange transfusion.”
Jaundice In Newborns- When To Worry?
Let us reemphasize that jaundice is generally NOT dangerous in babies who were born full term and who do not have other medical problems. However, if the bilirubin levels get too high, jaundice can lead to more severe and serious complications like damage to brain and nervous system or a condition called kernicterus, which can result in deafness or delayed development.
Call your doctor if your baby’s skin continues to become more yellow with time or if your jaundiced baby seems listless or sick or is difficult to awaken. In addition, if your baby’s mild case of jaundice lasts more than three weeks, again consult his pediatrician.