Definition
Newborn jaundice is a condition marked by high levels of bilirubin in the blood. The increased bilirubin cause the infant's skin and whites of the eyes (sclera) to look yellow.
Alternative Names
Jaundice of the newborn; Neonatal hyperbilirubinemia
Causes, incidence, and risk factors
Bilirubin is a yellow pigment that's created in the body during the normal recycling of old red blood cells. The liver processes bilirubin in the blood so that it can be removed from the body in the stool.
Before birth, the placenta -- the organ that nourishes the developing baby -- removes the bilirubin from the infant so that it can be processed by the mother's liver. Immediately after birth, the baby's own liver begins to take over the job, but this can take time. Therefore, bilirubin levels in an infant are normally a little higher after birth.
High levels of bilirubin in the body can cause the skin to look yellow (which is called jaundice). Jaundice is present to some degree in most newborns. Such "physiological jaundice" usually appears between day 2 and 3, peaks between days 2 and 4, and clears by 2 weeks. Physiological jaundice usually causes no problems.
Breast milk jaundice is another common, usually non-harmful form of newborn jaundice. Breast milk may contain a substance that increases reuse of bilirubin in the intestines. Such jaundice appears in some healthy, breastfed babies after day 7 of life, and usually peaks during weeks 2 and 3. It may last at low levels for a month or more.
Breastfeeding jaundice is a type of exagerated physiological jaundice seen in breastfed babies in the first week, especially in those that are not nursing often enough. It is different than breast milk jaundice in that it occurs later and is caused by the milk itself.
Sometimes jaundice can be a sign of a serious underlying problem. Higher levels of bilirubin can be due to:
- An event or condition that increases the number of red blood cells that needs to be processed
- Anything that interferes with the body’s ability to process and remove bilirubin
The following increase the number of red blood cells that need to be processed:
- Abnormal blood cell shapes
- Blood type incompatibilities
- Cephalohematoma or other birth injury
- Glucose-6-phosphate dehydrogenase deficiency
- High levels of red blood cells (polycythemia)
- More common in small for gestational age babies
- More common in some twins
- Infection
- Prematurity
- Pyruvate kinase deficiency
- Transfusions
The following interfere with the body's ability to process and remove bilirubin:
In otherwise healthy babies born at 35 weeks gestation or greater, those most likely to eventually develop signs of newborn jaundice are those who have:
- A brother or sister who needed phototherapy for jaundice
- A high bilirubin level for their age, even if they are not yet jaundiced
- Been exclusively breastfeed, especially if weight is excessive
- Blood group incompatibility or other known red blood cell disease
- Cephalohematoma or significant bruising
- East Asian ancestry
- Jaundice in the first 24 hours of life
Symptoms
The main symptom is a yellow color of the skin. The yellow color is best seen right after gently pressing a finger onto the skin. The color sometimes begins on the face and then moves down to the chest, belly area, legs, and soles of the feet.
Sometimes, infants with significant jaundice have extreme tiredness and poor feeding.
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