When Should I Be Concerned About My Newborn's Jaundice?

Newborn jaundice refers to the yellowish discoloration of the skin and eyes. Jaundice is also called hyperbilirubinemia because it occurs when a yellow substance called bilirubin is elevated in the blood. Bilirubin is formed when red blood cells (RBCs) are broken down in the body, which normally occurs when old RBCs are replaced by new ones.

You can check the development of jaundice in your baby by gently pressing on their forehead to lightly blanch the skin. If the skin that was pressed appears yellow, it may indicate jaundice. Since it may be difficult to detect jaundice in babies with a darker complexion, always examine your baby in natural light. You can also look for jaundice under the baby’s tongue or on the white of their eyes.

Jaundice occurs when the rate of formation of bilirubin exceeds the rate of removal from the body via stool and urine. Most babies develop jaundice as a normal occurrence, also known as physiological jaundice. This happens because the bilirubin produced by the baby in the womb is removed by the placenta. After birth, the baby’s liver may need some time to mature enough to complete this task on its own.

Newborn jaundice may also be caused by certain conditions:

• Preterm birth. Premature babies do not have sufficiently developed liver functions and are more vulnerable to developing jaundice.
• Breast milk jaundice. Breast milk jaundice occurs due to certain substances in breast milk that can hamper the body’s ability to get rid of bilirubin. Breast milk jaundice generally develops within the first week after birth, around day 4 or 5, peaks within the first 2 weeks, then takes many weeks to go away. Breast milk jaundice does not mean the mother should stop breastfeeding the baby if the baby is feeding and growing well and gaining weight.
• Not enough breast milk. Babies who do not receive enough breast milk due to issues such as poor latching or reduced breast milk production may lose a lot of weight, which can cause a rise in bilirubin levels.
• Certain ethnicities. Babies of East Asian or Mediterranean descent have a higher likelihood of getting jaundice.

Other conditions that may cause newborn jaundice include the following:

• Trauma or injuries during birth, such as large bruises
• Incompatibility between the mother’s and baby’s blood types (particularly Rh incompatibility)
• Conditions that cause increased red blood cell breakdown (such as sickle cell anemia, hemophilia, and G-6-PD deficiency)
• Infections
• Liver diseases

Treatment of newborn jaundice mainly depends on the severity and cause of raised bilirubin levels. To bring your baby’s bilirubin down, your doctor may suggest:

• Phototherapy. A special type of blue light may be used to lower the bilirubin levels. Sunlight exposure is no longer recommended, as too much sun exposure can cause sunburn.
• Exchange transfusion. In this procedure, the baby’s blood is replaced with donated blood to lower bilirubin levels. It is usually done in babies with very high bilirubin levels or those who are unresponsive to other treatments. It can be a life-saving procedure because excessively high bilirubin levels can damage the baby’s brain.
• Intravenous (IV) immunoglobulins. This may be done for babies whose jaundice is caused by blood type incompatibility with the mother’s.
• Intravenous fluids. Babies with severe dehydration or electrolyte imbalances may be administered IV fluids.