Neonatal Jaundice

Topics: Bilirubin, Neonatal jaundice, Infant Pages: 6 (1503 words) Published: October 11, 2011
Newborn jaundice
Newborn jaundice is a condition marked by high levels of bilirubin in the blood. The increased bilirubin causes the infant's skin and whites of the eyes (sclera) to look yellow.

Bilirubin is a yellow pigment that is created in the body during the normal recycling of old red blood cells. The liver helps break down bilirubin 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. This is called jaundice.

Jaundice is present to some degree in most newborns, and is called "physiological jaundice." It usually appears between day 2 and 3, peaks between days 2 and 4, and clears by 2 weeks. Physiological jaundice usually causes no problems.

Other types of jaundice that usually cause no harm include:

Breast milk jaundice is probably caused by factors in the breast milk that slow the rate at which the liver breaks down bilirubin. 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 seen in breastfed babies in the first week of life, especially in babies who are not nursing often enough. Breastfeeding jaundice is different than breast milk jaundice. Babies who are born too early (premature) are more likely to develop jaundice than full-term babies.

Conditions that increase the number of red blood cells that need to be broken down, and can cause more severe newborn jaundice:

Abnormal blood cell shapes
Blood type mismatch between the mother and the baby
Bleeding underneath the scalp (cephalohematoma) caused by a difficult delivery Higher levels of red blood cells, which is more common in small-for-gestational-age babies and some twins Infection
Lack (deficiency) of certain important enzymes
Conditions that make it harder for the baby's body to remove bilirubin may also lead to more severe jaundice:

Certain medications
Congenital infections, such as rubella, syphilis, and others Diseases that affect the liver or biliary tract, such as cystic fibrosis or hepatitis Hypoxia
Infections (such as sepsis)
Many different genetic or inherited disorders
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.

Exams and Tests
Doctors, nurses, and family members will watch for signs of jaundice at the hospital, and after the newborn goes home.

Any infant who appears jaundiced should have bilirubin levels measured right away. This can be done with a blood test.

Many hospitals check total bilirubin levels on all babies at about 24 hours of age. Hospitals use probes that can estimate the bilirubin level just by touching the skin. High readings need to be confirmed with blood tests.

Tests that will likely be done include:

Complete blood count
Coomb's test
Reticulocyte count
Further testing may be needed for babies who need treatment or whose total bilirubin levels are rising more quickly than expected.

Treatment is usually not needed.

When determining treatment, the doctor must consider:

The baby's bilirubin level
How fast the level has been rising
Whether the baby was born early (babies born early are more likely to be treated at lower bilirubin levels) How old the baby is now
Your child will need treatment if the bilirubin...

References: American Academy of Pediatrics (AAP). Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation. Pediatrics. 2004;114:297-316.
Mercier CE, Barry SE, Paul K, et al. Improving newborn preventive services at the birth hospitalization: a collaborative, hospital-based quality-improvement project. Pediatrics. 2007;120:481-488.
Moerschel SK, Cianciaruso LB, Tracy LR. A practical approach to neonatal jaundice. Am Fam Physician. 2008;77:1255-1262.
Update Date: 11/12/2010
Updated by: Neil K. Kaneshiro, MD, MHA, Clinical Assistant Professor of Pediatrics, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
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