What causes jaundice?

Jaundice can develop when red blood cells break down and bilirubin is left. It is normal for some red blood cells to die every day. In the womb, the mother’s liver removes bilirubin for the baby, but after birth the baby’s liver must remove the bilirubin. In some babies, the liver might not be developed enough to efficiently get rid of bilirubin. When too much bilirubin builds up in a new baby’s body, the skin and whites of the eyes might look yellow. This yellow coloring is called jaundice. What are some of the signs of jaundice? Jaundice usually appears first on the face and then moves to the chest, belly, arms, and legs as bilirubin levels get higher. The whites of the eyes can also look yellow. Jaundice can be harder to see in babies with darker skin color. Your baby’s doctor or nurse can test how much bilirubin is in your baby’s blood.

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Are some babies more likely to be jaundiced?

About 60% of all babies have jaundice. Some babies are more likely to have severe jaundice and higher bilirubin levels than others. Babies with any of the following risk factors need close monitoring and early jaundice management:

• Sibling: A baby with a brother or sister that had jaundice is more likely to develop jaundice.
• Feeding difficulties: A baby who is not eating, wetting, or stooling well in the first few days of life is more likely to get jaundice.
• Bruising: A baby who has bruises at birth is more likely to have jaundice. A bruise forms when blood leaks out of a blood vessel and causes the skin to look black and blue. Then, when the bruise begins to heal, red blood cells die. Bilirubin is made when red blood cells break down. The healing of large bruises may cause high levels of bilirubin, and the baby may become jaundiced.
• Early jaundice: A baby who is yellow in the first 24 hours of life may get dangerously jaundiced.
• Heredity: A baby born to an East-Asian or Mediterranean family is at a higher risk of becoming very jaundiced. Also, jaundice is harder to see in babies with darker skin tones. Some families inherit conditions (such as G6PD), and their babies are more likely to become jaundiced.
• Preterm babies: Babies born before 37 weeks, or 8 ½ months, of pregnancy may become jaundiced because their liver may not be fully developed. The young liver may not be able to get rid of so much bilirubin. If too many red blood cells break down at the same time, the baby can become very yellow or may even look orange.
• Blood type: Women with an O blood type or Rh negative blood factor might have babies with higher bilirubin levels. A mother with Rh incompatibility should be given Rhogam.

Does jaundice always cause a problem?

Many babies have some jaundice. Jaundice can develop when red blood cells break down and bilirubin is left. It is normal for some red blood cells to die every day. In the womb, the mother’s liver removes bilirubin for the baby, but after birth the baby’s liver must remove the bilirubin. In some babies, the liver might not be developed enough to efficiently get rid of bilirubin. When too much bilirubin builds up in a new baby’s body, the skin and whites of the eyes might look yellow. This yellow coloring is called jaundice. The yellow color does not hurt the baby's skin, but the bilirubin goes to the brain as well as to the skin. When severe jaundice goes untreated for too long, it can cause brain damage and a condition called kernicterus.

How do you measure billirubin?

Before leaving the hospital with your newborn, ask your doctor or nurse about a jaundice bilirubin test.

A doctor or nurse may screen your baby’s bilirubin using a light meter that is placed on the baby’s head (as pictured). This results in a transcutaneous bilirubin (TcB) level. If it is high, a blood test will likely be ordered.

The best way to accurately measure bilirubin is with a small blood sample from the baby’s heel.

This results in a total serum bilirubin (TSB) level. If the level is high, based upon the baby’s age in hours and other risk factors, treatment will likely follow. Repeat blood samples will also likely be taken to ensure that the TSB decreases with the prescribed treatment.

If bilirubin levels are too high, what treatments are there?

Treatment for high levels of bilirubin will be ordered by your doctor or nurse.

Phototherapy

Your baby is placed in contact with special lights that break down the bilirubin in the body. Phototherapy may be delivered through a blanket or light source around the baby’s incubator or bassinet. This may be done in the hospital or at your home. Your doctor or nurse will prescribe the best form of treatment for your baby.

Exchange transfusions

A blood transfusion may be needed if the bilirubin in your baby's body reaches extreme levels.

What is kernicterus?

Kernicterus is a type of brain damage that causes athetoid cerebral palsy and hearing loss. It also causes problems with vision and teeth and sometimes can cause mental retardation.

Who can develop kernicterus?

Any baby with untreated jaundice is at risk for kernicterus. This does not mean that every baby with yellow skin will have brain damage. Most babies with jaundice get better by themselves. If their skin is very yellow, they might need phototherapy treatment. If phototherapy does not lower the baby's bilirubin levels, the baby may need an exchange transfusion.

What are some warning signs of kernicterus?

Ask your pediatrician to see your baby the day you call, if your baby

• Is very yellow or orange (skin color changes start from the head and spread to the toes)
• Is hard to wake up or will not sleep at all
• Is not breastfeeding or sucking from a bottle well
• Is very fussy
• Does not have at least 4 wet or dirty diapers in 24 hours

Can jaundice be treated and prevent kernicterus from developing?

Yes, it can. When being treated for high bilirubin levels, your baby will be undressed and put under special blue lights most of the day (see above picture). The lights will not hurt the baby. They are warm and probably feel good. This can be done in the hospital or at home. The baby’s milk intake may also need to be increased. In some cases, if the baby has very high bilirubin levels, the doctor will do an exchange transfusion of the baby’s blood. Jaundice is generally treated before brain damage is a concern. Putting your baby in sunlight is not recommended as a safe way of treating jaundice. No baby should develop brain damage from untreated jaundice.

What should I do if I think my baby has jaundice?

Call and visit your baby's doctor right away.