Contributor: Kadakkal Radhakrishnan, MD
All parents want after the birth of their child is a healthy and perfect bundle of joy. So when the baby comes out with yellowish eyes and skin, most moms and dads start to panic. This yellow discoloration in a newborn is called jaundice, and it’s a common issue.
Jaundice is due to an elevated level of yellowish pigment in the blood called bilirubin that forms when the baby’s body breaks down red blood cells. Bilirubin is carried through blood to the liver, where it’s tagged to a chemical and excreted into bile, the green pigment made by the liver, and then moves out of the body as waste.
When the new baby begins breathing after birth, the excess red blood cells the baby had while in the uterus are broken down. This generates a higher level of bilirubin in all babies after birth.
This relatively higher load of bilirubin and the inability of many infants’ liver to optimally excrete the bilirubin cause newborns to have higher levels of bilirubin.
Sometimes, premature birth or an underlying disorder may aggravate the jaundice.
It’s normal for babies born at term to have at least some jaundice that affect their eyes and face, and this should not cause any problems. Therefore, it’s nothing to worry about. This is typically seen on the baby’s second or third day of life, and it’s called physiological jaundice.
Some breast-fed babies may have more jaundice than babies who aren’t breast-fed, but this should not be a reason to stop breast-feeding. However, talk to your child’s doctor if you have concerns about jaundice and questions related to breast-feeding.
If the jaundice is apparent on the first day of a child’s life or it affects the chest or abdomen, it’s a sign the level of bilirubin may be higher than the norm. In this case, the infant should be evaluated by a pediatrician.
When the onset of jaundice occurs on the first day or if the jaundice is prolonged, the problem could be beyond physiologic jaundice. Other issues could include blood group incompatibility, infection in the blood stream, certain viral infections, abnormalities of certain enzymes and abnormalities of the red cell membrane.
If jaundice is prolonged beyond one week of life, then problems related to the liver that affect the flow of bile to the intestine will have to be considered. The most common of these is biliary atresia, a disorder that leads to blockage in the bile ducts – the tubes that drain bile from the liver to the intestine.
Often, an elevated bilirubin does not lead to any major health problems. However, very high levels or inadequately treated elevated levels may cause brain damage, and the risk is higher for premature babies. But before you worry, know that this is uncommon.
Most often, physiologic jaundice does not require treatment and will improve on its own. However, if the jaundice spreads to the chest or abdomen, a pediatrician will need to check the baby’s bilirubin level. The decision to treat is based on the level of bilirubin and the maturity of the baby, and this decision should be made with the help of your child’s doctor.
Placing the baby under light, called phototherapy, is the most common treatment to lower bilirubin levels – if considered high enough to be treated.
Phototherapy often requires hospitalization, and a premature baby may need a more aggressive treatment than does a full-term infant.
Occasionally, a jaundice vest, or BiliBlanket – a portable phototherapy device – may be used for a baby’s bilirubin levels that are elevated but not considered high enough for hospitalization. This blanket can be used at home while monitoring the baby’s bilirubin level, if your physician approves.
Whether the newborn has physiological jaundice or requires more intensive treatment, it’s important the baby is feeding well. Good feeding promotes good bowel movements and ensures adequate excretion of bilirubin though the intestine. For this reason, your doctor may advise supplementary feeding beyond breast-feeding.
For very high elevation of bilirubin when there are blood group incompatibilities between the baby and mother, intravenous immunoglobulin may be used to reduce destruction of red blood cells.
Although rare, when severe jaundice does not respond to other types of therapy, an exchange transfusion may be required. In this procedure, the baby’s blood is exchanged in small volumes, which dilutes the bilirubin and maternal antibodies. This requires close monitoring and needs to be done in a neonatal intensive care unit.
Babies with prolonged jaundice beyond one week will need to be evaluated for disorders affecting the liver, and they’ll need their conjugated bilirubin measured. If the conjugated bilirubin is elevated, the baby may have biliary atresia. For newborns with biliary atresia, surgery can often help improve bile flow, if performed before two months of age.
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This post is based on one of a series of articles produced by U.S. News & World Report in association with the medical experts at Cleveland Clinic.