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Newborn jaundice

Definition

Newborn jaundice is when a baby has a high level of bilirubin in the blood. Bilirubin is a yellow substance that the body creates when it replaces old red blood cells. The liver helps break down the substance so it can be removed from the body in the stool.

High levels of bilirubin make your baby's skin and whites of the eyes look yellow. This is called jaundice.

Alternative Names

Jaundice of the newborn; Neonatal hyperbilirubinemia; Bili lights - jaundice

Causes

It is normal for a baby's bilirubin level to be a bit higher after birth.

When the baby is growing in the mother's womb, the placenta removes bilirubin from the baby's body. The placenta is the organ that grows during pregnancy to feed the baby. After birth, the baby's liver starts doing this job. It may take some time for the baby’s liver to be able to do this efficiently.

Most newborns have some yellowing of the skin, or jaundice. This is called "physiological jaundice." It is often most noticeable when the baby is 2 - 4 days old. Most of the time it does not cause problems and goes away within 2 weeks.

Two types of jaundice may occur in newborns who are breastfed. Both types are most often harmless.

Severe newborn jaundice may occur if your baby has a condition that increases the number of red blood cells that need to be replaced in the body, such as:

Things that make it harder for the baby's body to remove bilirubin may also lead to more severe jaundice, including:

Babies who are born too early (premature) are more likely to develop jaundice than full-term babies.

Symptoms

Jaundice causes a yellow color of 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 a lot of jaundice may be very tired and feed poorly.

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:

Further testing may be needed for babies who need treatment or whose total bilirubin levels are rising more quickly than expected.

Treatment

Treatment is not needed most of the time.

When treatment is needed, the type will depend on:

A baby will need treatment if the bilirubin level is too high or is rising too quickly.

A baby with jaundice needs to be kept well hydrated with breast milk or formula.

Some newborns need to be treated before they leave the hospital. Others may need to go back to the hospital when they are a few days old. Treatment in the hospital usually lasts 1 to 2 days.

Sometimes special blue lights are used on infants whose levels are very high. These lights work by helping to break down bilirubin in the skin. This is called phototherapy.

If the bilirubin level is not too high or is not rising quickly, you can do phototherapy at home with a fiberoptic blanket, which has tiny bright lights in it. You may also use a bed that shines light up from the mattress.

In the most severe cases of jaundice, an exchange transfusion is required. In this procedure, the baby's blood is replaced with fresh blood. Giving babies with very bad jaundice intravenous immunoglobulin may also be effective at reducing bilirubin levels.

Outlook (Prognosis)

Newborn jaundice is not harmful most of the time. For most babies, jaundice will get better without treatment within 1 to 2 weeks.

Very high levels of bilirubin can damage the brain. This is called kernicterus. However, the condition is almost always diagnosed before levels become high enough to cause this damage.

For babies who need treatment, the treatment is very often effective.

Possible Complications

Rare, but serious complications from high bilirubin levels include:

When to Contact a Medical Professional

All babies should be seen by a health care provider in the first 5 days of life to check for jaundice.

Jaundice is an emergency if the baby has a fever, has become listless, or is not feeding well. Jaundice may be dangerous in high-risk newborns.

Jaundice is generally NOT dangerous in babies who were born full term and who do not have other medical problems. Call the infant's health care provider if:

Prevention

In newborns, some degree of jaundice is normal and probably not preventable. The risk of serious jaundice can often be reduced by feeding babies at least 8 to 12 times a day for the first several days and by carefully identifying infants at highest risk.

All pregnant women should be tested for blood type and unusual antibodies. If the mother is Rh negative, follow-up testing on the infant's cord is recommended. This may also be done if the mother's blood type is O+, but it is not needed if careful monitoring takes place.

Careful monitoring of all babies during the first 5 days of life can prevent most complications of jaundice. This includes:

References

Buescher JJ, Bland H. Care of the newborn. In: Rakel RE, ed. Textbook of Family Medicine. 8th ed. Philadelphia, PA: Saunders Elsevier; 2011:chap 22.

Watchko JF. Neonatal indirect hyperbilrubinemia and kernicterus. In: Gleason CA, Devaskar SU. Avery's Diseases of the Newborn. 9th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 79.

Maheshwari A, Carlo WA. Digestive system disorders. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 19th ed. Philadelphia, PA: Saunders Elsevier; 2011:chap 96.


Review Date: 12/4/2013
Reviewed By: Neil K. Kaneshiro, MD, MHA, Clinical Assistant Professor of Pediatrics, University of Washington School of Medicine, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Bethanne Black, and the A.D.A.M. Editorial team.
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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