Jaundice in newborns is common. It occurs to almost every baby in the first few days of life. Jaundice is not a disease. It refers to the color of the skin or white parts of the eyes called the sclera. Babies of all races develop jaundice though it is harder to see it in darker skinned infants. The best way to check the color is in bright sunlight or under fluorescent lighting. Unless you have seen many, many jaundiced babies, it is not that easy to spot. If someone comments that your baby has “a beautiful skin color” it is wise to ask if he is jaundiced. Mild jaundice is not harmful.
Causes
Jaundice is the result of elevated levels of bilirubin in the infant’s blood. This is a normal finding and due to the baby having to process her own bilirubin for the first time. Before birth, her mother’s liver did it for her and her own immature liver is just beginning to take over. A baby who has a great deal of bruising from delivery or had a vacuum extraction will likely have higher levels of bilirubin. There are some rare metabolic diseases that cause elevated bilirubin levels and those babies are usually markedly jaundiced before 24 hours of age.
Testing
Your baby will have a blood test for bilirubin levels at 24 hours and at 48 to 72 hours. If you and your baby are discharged from the hospital prior to 72 hours, the pediatrician or nurse practitioner will want to see him within two days to repeat the test. The American Academy of Pediatrics recommends this practice and it is performed in nearly every hospital in the United States. Without screening, elevated bilirubin levels that go undiscovered may lead to a dangerous neurological condition called Kernicterus. Fortunately, this is rare.
Management
Usually, no treatment is required. For all babies, it is important to keep the infant well hydrated, see that he is breastfeeding or bottle feeding well and having plenty of wet and soiled diapers. In the case of an elevated bilirubin outside the accepted range, phototherapy may be required. There are several ways to do this. In one situation, the infant lies in an isolette with ultraviolet lights on. It looks very much like she is lying in a tanning bed especially since she will be wearing eye shields. There are also phototherapy lamps and blankets, which may be used. The doctor will order the method that is right for your baby’s bilirubin level. Hydration is especially important under phototherapy.
When to Call the Doctor
Once you are home, it is important to call your infant’s doctor if he appears more jaundiced especially on his legs, arms or belly. If the whites of his eyes are yellow, it warrants a call as well. Breastfed babies are statistically more likely to become jaundiced although no one knows for sure why. Breast or bottle fed, if your baby is not feeding well or becomes especially sleepy, call the doctor.
Misconceptions
Newborns have always been jaundiced and have mostly done fine. For a period of time, routine bilirubin testing was discontinued and more babies developed consequences of very high bilirubins that were not treated. It is never adequate treatment to place a jaundiced baby by a sunny window. Newborns who are jaundiced because they have elevated bilirubins need to be managed by their doctors or nurse practitioners to prevent damage and disability.