Parenting in the Early Years


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Recognizing Illness

Jaundice, also called hyperbilirubinemia, is the yellow discoloration of the skin frequently seen in newborns.

When infants are born, they have a special type of blood called fetal hemoglobin. Shortly after birth they go through a process of breaking down the fetal hemoglobin and forming adult hemoglobin.

In the process of breaking down the cells a substance called bilirubin is released. The liver then removes the bilirubin from the blood and excretes it in the stool. Jaundice occurs when bilirubin is produced faster than it is removed.

Most babies have low levels of bilirubin called physiologic jaundice, which is not dangerous. High levels of bilirubin can cross into the brain and cause injury. Full-term healthy infants are at a low risk for injury from jaundice unless the level is very high. Pre-term or ill infants are at risk for harm at lower levels of bilirubin. The bilirubin level may be checked by taking a measurement on the skin with bilirubin meter. If necessary, a blood sample, obtained by a small poke on the heel, will be taken to measure a baby's bilirubin level.

Causes of Jaundice

There are many causes of jaundice. The most common is the normal physiologic jaundice described above. Some other reasons jaundice develops include different blood types between the mother and infant, excessive bruising at birth, a high red blood cell count at birth, infection or liver disease.

Breastfed babies may have bilirubin levels that become higher and last longer which can usually be addressed by feeding more frequently and improving the baby's hydration. Rarely jaundice can be caused by a chemical in the breast milk, at which time your doctor will advise how best to proceed.

Jaundice usually occurs after a baby's first 48 hours of life, and may be present for the first four to six weeks of life. Jaundice is first seen on a baby's face, and as the bilirubin level rises, the yellow discoloration progresses down the chest, abdomen, and then the legs.

Treating Jaundice

Methods used to treat elevated bilirubin levels include improving nutrition and hydration by increasing the frequency of feedings. Stooling may be stimulated, as this is the body's way to get rid of the bilirubin. Placing a baby by a sunny window (never direct sun outside) will also help, as light is known to break down bilirubin.

If the bilirubin level becomes a concern to your doctor, other methods of treatment may be used. One treatment, called phototherapy, involves placing the baby in a special bed or blanket with a light source. If a baby's bilirubin level is very high, a process called exchange transfusion (where the baby's blood is replaced with new blood) will be undertaken. This is a rare event.

If your baby is jaundiced, your doctor will let you know what treatment method will work best for your baby.

Remember, if jaundice appears after you are discharged from the hospital, or if it becomes more intense at home, schedule an appointment with your doctor to check your baby. When in doubt, call your doctor.