Newborn jaundice is a condition caused by increased levels of bilirubin (a byproduct of the normal breakdown of red blood cells by the liver) which gives an infant's skin and eyeballs a yellowish tinge.

Alternative Names

Jaundice of the newborn; Physiologic jaundice of the newborn

Causes, incidence, and risk factors

Physiologic jaundice of the newborn, the most common cause of newborn jaundice, is present to some degree in almost all newborns. At birth, babies have relatively immature liver function. Therefore, even the normal destruction of red blood cells by the liver in the newborn infant can cause jaundice. This form of jaundice usually appears between the 2nd and 5th days of life and clears by 2 weeks. It usually causes no problems. Breast-feeding jaundice is seen in 5-10% of newborns. It is similar to physiologic jaundice, but bilirubin levels tend to be slightly higher. This occurs when breast-fed babies do not take in enough breast milk and rarely requires treatment. Sometimes, however, breast-feeding does need to be interrupted and bottle-feeding substituted for a brief period of time to clear the jaundice. Jaundice in a newborn is rarely caused by a serious illness. Disorders which can cause jaundice in a baby include:

biliary atresia

ABO incompatibility

(similar to a

transfusion reaction , caused when fetal and maternal blood mingle before birth)

Rh incompatibility

(

Anti-Rh antibodies )

galactosemia

(see

galactosemia screen )

cephalohematoma

polycythemia

glucose-6-phosphate dehydrogenase deficiency

neonatal

sepsis

congenital cytomegalovirus

infection (CMV)

congenital

toxoplasmosis

congenital

syphilis

congenital herpes

congenital

rubella

late

pregnancy administration of sulfa drugs to the mother

Crigler-Najjar syndrome

spherocytosis

(congenital

hemolytic anemia )

cystic fibrosis

pyruvate kinase

deficiency

thalassemia

Gilbert's syndrome

congenital

hypothyroidism

Lucey-Driscol syndrome

Gaucher's disease

Niemann-Pick disease

Signs and tests

elevated serum

bilirubin level

Treatment

Treatment is usually unnecessary. In all cases, it is important to keep the baby well-hydrated (breast milk and formula are preferable to glucose water) and encourage frequent bowel movements by feeding frequently. This is because broken down bilirubin is carried out of the body by the intestines in the stools (bilirubin is what gives stool their brown color). Sometimes artificial lights are used on infants whose levels are very high, or in premature infants. 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. 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)

The jaundice usually resolves without treatment within 1 to 2 weeks.

Complications

Kernicterus , brain damage from very high bilirubin levels is rare. Other rare, but serious, complications from high bilirubin levels include deafness and cerebral palsy.

Calling your health care provider

Call the infant's health care provider if jaundice is severe (the skin is bright yellow), if jaundice lasts longer than 1 or 2 weeks, or if other symptoms develop. Jaundice is an emergency if the baby has a fever, has become listless, or is not feeding well.

Prevention

Physiologic jaundice is a normal occurrence and probably not preventable. Prevention of disease-related jaundice is related to the specific disease (see the specific disease). Since babies are now sent home from the hospital quickly or are often born in settings like birthing centers, it is important for parents to be on the lookout for jaundice in their infants in the first few weeks of life.