JAUNDICE

Definition: Yellow appearance of the skin caused by bile pigment deposits in the skin.

1. What is jaundice, and what caused it to appear in my baby?

Jaundice is a common condition occurring in newborn babies. It is a yellowish skin discoloration caused by a waste product in the body called bilirubin. Bilirubin is produced when certain proteins and red blood cells are destroyed, which is a normal process that happens early on after birth. Newborns are more likely to be jaundiced due to increased destruction of red blood cells and the body’s slow processing of bilirubin due to an immature functioning liver.

2. Is jaundice dangerous?

In the majority of cases, jaundice is not a life-threatening or serious condition. The bilirubin levels can get high enough that treatment is needed. In most cases the treatment is relatively simple with special lights (see question #5). If the bilirubin level gets to a serious level, then an exchange of the baby’s blood (exchange transfusion) may be necessary. Fortunately, this is a rare occurrence.

3. What tests are needed to further define the condition?

Most of the time, a meter will first be placed to the baby’s forehead as a screening test. If the meter level is elevated, then it will be necessary to do a blood test to measure the bilirubin level. A test for the blood type of the infant is generally necessary to determine if it is compatible with the mother’s blood type, but most of the time this is done on blood from the umbilical cord at the time of delivery. If there is a concern about rapid destruction of the red blood cells, a blood count may be necessary.

4. What is considered to be a danger point for the bilirubin level?

The actual level that treatment is started is dependent on the baby’s age at birth, the number of days since birth, and whether or not there are conditions causing increased and more rapid red blood cell destruction. If the bilirubin level is rising quickly or approaching 20 mg/dL or more, therapy is generally started. Levels above 25 mg/dL have been associated with deposits of bilirubin (staining) on portions of the brain in some babies. This staining can lead to brain damage and lifelong injury.

5. If my baby’s bilirubin level exceeds the danger point, what kind of therapy will be given and will it correct the problem?

The main therapy is phototherapy. The baby is given eye protection and is placed with minimal clothing under special blue lights. These lights help in the removal of bilirubin. Phototherapy usually lasts from two to five days. If the baby is dehydrated, IV fluids may be started to correct the dehydration. Sometimes, breast-feeding and breast milk may not be given while the baby is under treatment for the jaundice.

6. Is phototherapy safe, and will there be any bad consequences afterward?

Phototherapy with appropriate eye protection has no serious side effects. Sometimes babies pass more stools while under phototherapy. Also since they are uncovered, some will require a heating source to prevent them from getting cold.

7. How often do we follow the bilirubin level, and will we continue to follow the level at home following discharge from the hospital?

If there are concerns, the bilirubin level is generally followed daily. This continues until the bilirubin level stabilizes or starts to drop. There may be a need for ongoing blood levels after discharge as the jaundice can persist for the first several weeks.

8. Can my baby become anemic from this disorder?

No, not from the jaundice itself. Jaundice is more severe in babies when there is a process that causes rapid or increased destruction of the red blood cells. There may be an incompatibility between the blood types of mother and baby, a defect in the red blood cells, or excessive bleeding or bruising that could cause the anemia and also make the baby more likely to have jaundice that requires treatment.

9. Is there anything else we need to know concerning this condition and its management?

Bilirubin is mainly passed from the body in the stool. Good feedings and ensuring good hydration in the first two to four days of life can decrease the risk of significant jaundice.

Very high levels of jaundice can lead to a condition called kernicterus. This is when parts of the brain are stained by the bilirubin. Kernicterus leads to cerebral palsy and lifelong abnormalities of the nervous system.

10. After discharge from the hospital, what kind of follow-up will be needed?

As discussed earlier, some babies require continued monitoring of the blood levels after discharge. This may be daily for several days. Some babies may require readmission to the hospital for treatment with phototherapy. Your pediatrician will instruct you on the frequency for the blood tests on discharge from the hospital. 

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