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Jaundiced Newborn

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Definition

  • Jaundice (yellow skin) in a baby during the first 3 months of life (90 days)
  • The skin turns a yellow color from high bilirubin levels in the blood

Jaundice and Bilirubin

  • Jaundice means the skin has turned yellow.
  • Bilirubin is the pigment that turns the skin yellow.
  • Bilirubin comes from the normal breakdown of old red blood cells.
  • The liver normally gets rid of bilirubin. But, at birth, the liver may be immature.
  • Half of babies have some jaundice. Usually it is mild.
  • The level of bilirubin that is harmful is around 20. Reaching a level this high is rare.
  • High levels need to be treated with bili-lights. That's why your doctor checks your baby's bilirubin levels until it becomes low.

Causes of Jaundice in Newborns

Physiological Jaundice (50% of newborns)

  • Onset 2 to 3 days of age
  • Peaks day 4 to 5, then improves
  • Disappears 1 to 2 weeks of age

Breastfeeding or Malnutrition Jaundice (5 to 10% of newborns)

  • Due to inadequate intake of breastmilk
  • Onset pattern similar to physiological type
  • Also, causes poor weight gain
  • Needs close follow-up and weight checks

Breastmilk Jaundice (10% of newborns)

  • Due to substance in breastmilk which blocks removal of bilirubin
  • Breastmilk intake and weight gain are normal
  • Onset 4 to 7 days of age
  • Lasts 3 to 12 weeks
  • Not harmful

Rh and ABO Blood Group Incompatibility (Serious, but Rare)

  • Onset during first 24 hours of life
  • Can reach harmful levels

Liver Disease (Serious, but Rare)

  • The main clue is light gray or pale yellow stools
  • The jaundice doesn't go away
  • Causes include liver infection (hepatitis) and liver blockage (biliary atresia)
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When To Call

Call 911 Now

  • Can't wake up
  • Not moving or very weak
  • You think your child has a life-threatening emergency

Go to ER Now

  • Feeding poorly (such as poor suck, does not finish)
  • Hard to wake up

Call Doctor or Seek Care Now

  • Age less than 1 month old and looks or acts abnormal in any way
  • Dehydration suspected. No urine in more than 8 hours, dark urine, very dry mouth and no tears.
  • Fever. Caution: do NOT give your baby any fever medicine before being seen.
  • Low temperature less than 96.8° F (36.0° C) rectally that does not go up with warming
  • Jaundice began during the first 24 hours of life
  • Skin looks deep yellow or orange
  • Jaundice has reached the legs
  • Jaundice worse than when last seen
  • You think your child needs to be seen, and the problem is urgent

Contact Doctor Within 24 Hours

  • High-risk baby for severe jaundice. Risk factors are: premature baby born at 36 weeks or less, ABO or Rh blood group problem, sib needed bili-lights, bleeding in the scalp, Asian race, breastfeeding problems.
  • Whites of the eyes have turned yellow
  • Jaundice spreads to stomach (belly)
  • You are worried about the amount of jaundice
  • You are worried your baby is not getting enough breastmilk
  • Yellow, seedy stools are less than 3 per day. Exception: breastfed and before 5 days of life.
  • Day 2-4 of life and no stool in more than 24 hours and breastfed
  • Wet diapers are less than 6 per day. Exception: 3 wet diapers per day can be normal before 5 days of life if breastfed.
  • 4 or more days old and has not been checked since discharge
  • You think your child needs to be seen, but the problem is not urgent

Contact Doctor During Office Hours

  • Color gets deeper yellow after 7 days old
  • Jaundice is not gone after 14 days of age
  • Jaundice began or comes back after 7 days of age
  • Stools are white, pale yellow or gray
  • You have other questions or concerns

Self Care at Home

  • Mild jaundice of newborn
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Care Advice

What You Should Know About Newborn Jaundice:

  • Some jaundice is present in 50% of newborns.
  • It lasts a short time and will go away. Most often, it is harmless.
  • The first place for jaundice to start is on the face.
  • Jaundice that is only of the face is always harmless.
  • Here is some care advice that should help.

Bottle Feed More Often:

  • If bottle fed, increase how often you feed your baby.
  • Try to feed every 2 to 3 hours during the day.
  • Don't let your baby sleep more than 4 hours at night without a feeding.

Breastfeed More Often:

  • If breastfed, increase how often your feed your baby.
  • Nurse your baby every 1½ to 2 hours during the day.
  • Don't let your baby sleep more than 4 hours at night without a feeding.
  • Goal: at least 10 feedings every 24 hours.

Infrequent Stools Means Your Baby Needs More Milk:

  • Breastmilk and formula help carry bilirubin out of the body. Therefore, good feedings are important for bringing down the bilirubin level.
  • In the first month, keep track of how many stools are passed daily. The number of stools reflects how much milk your baby is getting.
  • If your baby is 5 days or older, he should have at least 3 stools daily. If stooling less than that, it usually means your baby needs more to eat.
  • Try to increase the number and amount of feedings per day.
  • If you are having any trouble with breastfeeding, consult a lactation expert. Also, schedule a weight check.

What to Expect:

  • Physiological jaundice peaks on day 4 or 5.
  • It slowly goes away over 1-2 weeks.

Judging Jaundice:

  • Jaundice starts on the face and moves downward. Try to determine where it stops.
  • View your baby unclothed in natural light near a window.
  • Press on the skin with a finger to remove the normal skin tone.
  • Then try to look if the skin is yellow before the pink color returns.
  • Move down the body, doing the same. Try to look where the yellow color stops.
  • Jaundice that only involves the face is harmless. As it involves the chest, the level is going up. If it involves the eyes, stomach, arms or legs, the bilirubin level needs to be checked.

Call Your Doctor If:

  • Jaundice gets worse
  • Whites of the eyes turn yellow
  • Belly or legs turn yellow
  • Feeds poorly or has a weak suck
  • Baby starts to look or act abnormal
  • Jaundice lasts more than 14 days
  • You think your child needs to be seen

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Barton Schmitt MD, FAAP
Disclaimer: this health information is for educational purposes only. You, the reader, assume full responsibility for how you choose to use it.
Copyright 2000-2024. Schmitt Pediatric Guidelines LLC.
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