Newborn jaundice Health Article

Signs and tests

All newborns should be examined for jaundice at least every 8 to 12 hours for the first day of life.

Any infant who appears jaundiced in the first 24 hours should have bilirubin levels measured immediately. This can be done with a skin or blood test.

Babies should be assigned a risk for later developing jaundice before they leave the hospital. Doctors use hourly bilirubin levels to predict a baby’s odds of later developing jaundice. Babies are classified as low risk , low intermediate risk, high intermediate risk, or high risk. Many hospitals do this by routinely checking total bilirubin levels on all babies at about 24 hours of age.

Further testing varies on the infant's specific situation and test results. For example, the possible cause of the jaundice should be sought for babies who require treatment or whose total bilirubin levels are rising more rapidly than expected.

Tests that will likely be done include:

• Complete blood count
• Coomb's test
• Measurement of levels of specific types of bilirubin
• Reticulocyte count

Serum albumin levels may also be checked. Because bilirubin travels in the blood attached to albumin when possible, low albumin levels may increase the risk of damage from excessive jaundice.

Treatment

Treatment is usually not necessary. Keep the baby well-hydrated with breast milk or formula. Encourage frequent bowel movements by feeding frequently. This is because bilirubin is carried out of the body by the intestines in the stools. (Bilirubin is what gives stool their brown color).

Sometimes special blue lights are used on infants whose levels are very high. This is called phototherapy. These lights work by helping to break down bilirubin in the skin. The infant is placed naked under artificial light in a protected isolette to maintain constant temperature. The eyes are protected from the light. The American Academy of Pediatrics recommends that breastfeeding be continued through phototherapy, if possible.

In the most severe cases of jaundice, an exchange transfusion is required. In this procedure, the baby's blood is replaced with fresh blood. Recently, promising studies have shown that treating severely jaundiced babies with intravenous immunoglobulin is very effective at reducing the bilirubin levels to safe ranges.

Expectations (prognosis)

Usually newborn jaundice is not harmful. For most babies, jaundice usually resolves without treatment within 1 to 2 weeks. However, if significant jaundice is untreated, very high levels of bilirubin can damage the brain. For babies who require treatment, the treatment is usually quite effective.

Complications

Rare, but serious, complications from high bilirubin levels include:

• Kernicterus -- brain damage from very high bilirubin levels
• Deafness
• Cerebral palsy

Calling your health care provider

All babies should be seen by a health care provider in the first 5 days of life to check for jaundice.

• Those who spend less than 24 hours in a hospital should be seen by age 72 hours.
• Infants sent home between 24 and 48 hours should be seen again by age 96 hours.
• Infants sent home between 48 and 72 hours should be seen again by age 120 hours.

Jaundice is an emergency if the baby has a fever, has become listless, or is not feeding well. Jaundice may be dangerous in high-risk newborns.

Jaundice is generally NOT dangerous in term, otherwise healthy newborns. Call the infant's health care provider if jaundice is severe (the skin is bright yellow), if jaundice continues to increase after the newborn visit, lasts longer than 2 weeks, or if other symptoms develop. Also call the doctor if the feet, particularly the soles, are yellow.

Prevention

In newborns, some degree of jaundice is normal and probably not preventable. The risk of significant jaundice can often be reduced by feeding babies at least 8 to 12 times a day for the first several days and by carefully identifying infants at highest risk.

All pregnant women should be tested for blood type and unusual antibodies. If the mother is Rh negative, follow-up testing on the infant's cord is recommended. This may also be done if the mother blood type is O+, but it not necessarily required if careful monitoring takes place.

Careful monitoring of all babies during the first 5 days of life can prevent most complications of jaundice. Ideally, this includes:

• Considering a baby's risk for jaundice
• Checking bilirubin level in the first day or so
• Scheduling at least one follow-up visit the first week of life for babies sent home from the hospital in 72 hours