Jaundice

By Krista Gray, IBCLC. Last updated February 7, 2013.

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JaundiceWhat is it?

Jaundice is a very common condition in newborn babies that gives their skin and the whites of their eyes a yellow color.  It is usually harmless.

Also known as physiologic jaundice, it typically develops 2-3 days following birth and disappears by two weeks old.  However, in preterm babies it may take 5-7 days to show up and slightly longer to disappear.  It starts at the top of a baby’s body – head and face – and can spread downward to the head and chest.

The yellowing of the skin looks like a suntan, and can look darker when you press on the skin.  Jaundice that develops within the first 24 hours after birth needs medical attention and could have underlying medical causes. Breast milk jaundice is typically diagnosed around the time physiologic jaundice would be disappearing.  Though harmless, it can persist for many weeks.

Symptoms

Primary symptoms:

  • Yellowing of the skin and whites of the eyes

Secondary symptoms:

  • sleepiness
  • losing more than 7% of birth weight
  • poor sucking skills
  • dark urine (rather than colorless)
  • pale stools (rather than bright yellow)
  • high-pitched crying
  • limpness

Causes

The yellowing of the skin is caused by the buildup of bilirubin in the blood.  Typically, the liver filters bilirubin from the bloodstream and it exits the body through stools.  However, in newborns, bilirubin can build up faster than the liver can filter it…causing jaundice.

Some babies seem to be more susceptible:

  • Preterm babies (before 38 weeks gestation)
  • Low birth weight (under 5 ½ pounds)
  • If a previous child had jaundice

Rarely, jaundice is caused by other factors, such as the following:

  • Hypothyroidism
  • Urinary Tract Infections
  • Rhesus factor disease
  • Inherited enzyme deficiency
  • Baby experiences bleeding in/around skull due to difficult delivery
  • Mother has diabetes
  • Bowel obstruction in baby

Associated Risks of Jaundice

Jaundice is quite common and usually does not pose long-term health risks.  However, there is a small risk bilirubin could pass into the brain and cause brain damage if levels in the body get too high.  These excessively high levels of bilirubin, known as kernicterus, are very rare and tend to only be a significant problem in places where there is no access to quality medical care.

Treatment

It is estimated that 6 out of 10 babies will have jaundice.  By the time babies are two weeks old their bodies are producing less bilirubin and their livers are more effective at filtering, allowing jaundice to self-correct itself the majority of the time.  Therefore, most cases of jaundice do not require any treatment.

Frequent breastfeeding helps a newborn baby’s body pass stools more frequently, thereby allowing bilirubin to exit more quickly.  Waking a sleeping baby and ensuring a good latch for milk removal are very helpful in treating jaundice.  Sunlight on baby’s skin is another way to help the body breakdown bilirubin.

When babies have higher levels of bilirubin in their blood (confirmed by blood test) it is treated with phototherapy.  Phototherapy is a special light that shines on baby’s skin which helps to breakdown the bilirubin.

Though some medical professionals advocate formula to help pass jaundice symptoms more quickly, the benefits of this when weighed against the known pitfalls of formula are not supported by research.  While in the past, formula-feeding has been associated with reducing jaundice levels more quickly than breastfeeding by passing more stools, current research has not supported this and actually found stool output to be similar between breast milk and formula. 1 Some have postulated that since bilirubin has antioxidant effects it may actually compensate for deficiencies in the newborn.  Therefore, the best course is to breastfeed often, or pump to establish your supply and give this breastmilk to your jaundiced baby.

 

Show 1 footnote

  1. Buiter HD, Dijkstra SS, Oude Elferink RF, Bijster P, Woltil HA, Verkade HJ. (2008) Neonatal jaundice and stool production in breast- or formula-fed term infants. European Journal of Pediatrics. 167(5):501-7
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