If your newborn's beautiful skin has started turning a bit yellow, it could be jaundice. But your baby is in good company: Many infants experience this usually benign condition shortly after birth. Here are the basics on jaundice in newborn babies.
What is jaundice in babies?
Jaundice is a common, short-term condition in newborns that turns a baby's skin and the whites of the eyes yellow. Jaundice occurs in about 60 percent of all babies born full-term and about 80 percent of babies born prematurely when a chemical called bilirubin builds up in the baby's blood.
The American Academy of Pediatrics (AAP) recommends that all newborn babies have their bilirubin levels measured before leaving the hospital, with follow-up appointments scheduled as necessary based on the measured levels, their gestational age and other factors.[1]
Most cases show up two to three days after birth and are caught by these in-hospital screens, while others can appear later. Jaundice usually goes away on its own (or sometimes with mild treatment) with no ill effects. It usually lasts a week to 10 days, sometimes longer for premature babies.
What causes newborn jaundice?
Jaundice in a newborn baby is caused by excess levels of bilirubin, a condition known as hyperbilirubinemia. Bilirubin is an substance that's produced in the blood when the body breaks down old red blood cells.
Since a newborn's liver is underdeveloped, the bilirubin often doesn't get eliminated as efficiently, which can cause the skin, and sometimes the whites of the eyes, to turn yellow.
If your baby has jaundice, you'll be able to notice the yellow tinge of her skin by gently pressing on her forehead or chest and watching the color return.
There are various causes for newborn jaundice depending on type:
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Physiologic jaundice due to an underdeveloped liver
This is the most common type of jaundice, affecting 50 percent of all newborns. Why is it so common? A newborn's liver needs a little extra time to mature and get rid of the bilirubin in her body.[2]
Some experts call this type of jaundice a "normal" response in the first few days of life; it usually disappears within a week or two. This type of jaundice is very common in preemies, as their livers may not be fully developed.
Breast milk jaundice due to interference with liver function
Though relatively rare, about 10 percent of breastfed babies develop jaundice when a protein in breast milk blocks the liver's processing of bilirubin, causing elevated levels. It's rarely harmful, but still requires a doctor's evaluation in case some other cause is in play. A case can last anywhere from three to 12 weeks.
Jaundice due to breastfeeding problems or malnutrition
This type of jaundice occurs in about 5 to 10 percent of newborns due to low breast milk and calorie intake while a new mom and baby are getting acclimated to breastfeeding. While breastfeeding is still recommended for newborns who have jaundice, certain babies with this type of jaundice may require supplementing with pumped breast milk or formula in a bottle.
Jaundice from hemolysis
This rare but serious type of jaundice begins within the first 24 hours after birth. Several different things can cause what's called hemolytic disease of the newborn. Sometimes the baby's blood type does not match the mother's or their Rh factors are incompatible. In other cases, a hemoglobin disorder (G6PD deficiency), bleeding or infection can cause early jaundice.
Prenatal testing looks to prevent this condition. Moms-to-be who are Rh-negative will likely be treated with a RhoGAM injection because their Rh factor is negative and incompatible with the baby's.
Poor liver function
Again, this type of jaundice is rare but serious. The main clues that something is off are light gray or pale yellow stools in a newborn with jaundice that doesn't go away. It's caused by an infected liver (hepatitis) or blockage of the bile ducts of the liver (biliary atresia).
What are the symptoms of jaundice in a newborn baby?
Although there isn't anything you can do to prevent jaundice, it's important to watch for the telltale signs and symptoms, especially since the condition may not develop until after you bring your baby home from the hospital. That way, you can seek treatment if necessary.
Some symptoms of newborn jaundice are:
- Yellowing of the skin and eyes
- Pale-colored stool
- Dark (tea- or cola-colored) urine
Jaundice often appears on the face first and then spreads to the rest of the baby's body, including the chest, tummy, arms, legs and whites of the eyes. A good way to check is to place your baby in natural sunlight or under fluorescent lights and gently press her forehead and nose with your fingers.[3]
If the skin appears yellow where you made the impressions, call your pediatrician. The doctor will probably want to examine your baby and take a blood sample to look at the bilirubin levels in her blood.
Jaundice can be harder to see in babies with darker skin. In darker-skinned babies, the yellowing may be more visible on the palms of the hands and soles of the feet, so check there. Also look at the pink skin inside your baby's mouth in the gums and inner lips.
What are risk factors for jaundice?
While most babies have mild jaundice, some are at a greater risk, including:
- Babies born prematurely (before 37 weeks) or at a low birth weight
- Babies who lost a lot of weight right after delivery or had a lot of bruising or bleeding under the scalp related to labor and delivery
- Babies with a parent or sibling who had a high bilirubin level and received light therapy
- Babies who aren't breastfeeding well (because of poor latch, low milk supply, etc.)
If you're breastfeeding, feed your baby every two to three hours, or about eight to 12 times a day. Feeding this often helps keep your baby's bilirubin level down. If you're having trouble breastfeeding, ask your baby's doctor, nurse or a lactation specialist for help. It takes time to get the hang of it.
How is newborn jaundice treated?
If there are moderate to high levels of bilirubin detected in your baby, the pediatrician may recommend phototherapy treatment, which exposes the baby to a certain type of light via a special blanket or pad. Using "bili blankets" at home or hospital helps to break down bilirubin, making it easier for the body to eliminate.
(Because of newborns' substantial risk of sunburn with direct sunlight exposure, doctors these days do not recommend putting your baby in the sun.)
Your pediatrician may also tell you to feed your baby as often as possible, without overfeeding, to encourage frequent bowel movements. That will also help get rid of the excess bilirubin, which gives stools a brownish-yellowish color.
In the most extreme form of jaundice, when bilirubin levels are abnormally high, the chemical can build up in the brain. Left untreated, very severe jaundice can lead to an extremely rare condition called kernicterus, which can result in permanent brain damage.
Measuring all babies' bilirubin levels after birth helps ensure that these very uncommon instances of kernicterus are not missed.
If your baby has more severe jaundice, she may need treatments such as:
- Phototherapy treatment (also called light therapy or bili lights). Your baby will be undressed and put under special lights, but fear not: The lights don't hurt. Sometimes, you may need to bring your baby back to the hospital for treatment under the bili lights.
- Supplementing breast milk with formula. This is done on a case-by-case basis at the recommendation of your pediatrician and can sometimes help lower the bilirubin level and prevent the need for phototherapy.
- Red cell exchange transfusion. This treatment is called upon if bilirubin levels are abnormally high. In an exchange transfusion, your baby's blood is replaced with fresh donor blood or plasma. The need for this treatment is rare.
- Intravenous immunoglobulin (also called IVIg). This is a product made up of antibodies that can be given intravenously (through a vein). This is also only used rarely.
How long does it take for newborn jaundice to go away?
Typically, jaundice goes away in a week to 10 days, though it sticks around for longer in premature babies.
If your baby is breastfed, jaundice can last a month or occasionally longer. If your baby is formula-fed, jaundice typically clears up within two weeks. If it lasts three weeks or longer, be sure to call the doctor for a follow-up.
How can newborn jaundice be prevented?
There's no way to prevent the most common type of newborn jaundice. Most cases occur because a baby's liver is not mature enough to get rid of bilirubin in the bloodstream.
You can reduce your baby's risk of jaundice by:
- Getting a RHo-GAM shot, if your blood type is identified as Rh-negative during pregnancy and again 72 hours after delivery if your baby is Rh-positive.
- Feeding your baby at least eight to 12 times a day, which helps her have regular bowel movements and removes bilirubin from her body.
Though it's important to watch for the symptoms of jaundice and talk to your pediatrician right away if you suspect your baby could have it, take comfort in the fact that in most newborns, jaundice is an extremely treatable, manageable and mild condition that will likely go away in a matter of weeks.
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