How to Know if My Baby Has Neonatal Jaundice?

Neonatal jaundice refers to the yellow discoloration of a newborn baby’s skin, eyes, and mucous membranes, which is caused by high levels of bilirubin that build up in the blood.

Key takeaways:
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    Jaundice is the yellow discoloration of a newborn’s skin, eyes, and mucus membranes. It is caused by the liver’s inability to effectively process bilirubin, the breakdown product of red blood cells.
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    Prematurity, blood infection, blood type incompatibility, race, and dehydration are common causes of jaundice.
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    Phototherapy treatment is an effective way to lower bilirubin levels in the blood. If phototherapy is not successful, a blood exchange transfusion may be needed.
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    To help monitor for jaundice, parents should check their baby’s skin, feeding efficiency, and the number of wet/dirty diapers.

As red blood cells naturally break down, bilirubin is formed, and the liver filters it out of the body. Newborns, especially babies born prematurely, have more difficulty removing the excess bilirubin due to liver immaturity.

Symptoms

Neonatal jaundice usually appears within a couple of days after birth. Babies born prematurely (before 37 weeks gestation) are at a greater risk of developing high bilirubin levels in the blood. The skin, eyes, and mucous membranes inside the mouth will appear a yellowish color. Babies with darker skin may not have obvious signs of jaundice in the skin, so one cannot solely rely on skin color to determine high bilirubin levels.

The common symptoms of jaundice may include:

  • Yellowish color of skin, eyes, and inside the mouth.
  • Not breastfeeding long enough or inability to finish a bottle.
  • Excessive sleepiness, difficulty waking.
  • Decrease in wet or dirty diapers.
  • Irritability or high-pitched cry.

Causes

The normal process of red blood cells breaking down forms bilirubin, and the liver helps to filter it out of the body. Some newborns, especially babies born prematurely, will experience jaundice because their livers are immature and have more difficulty removing the bilirubin, causing it to build up and turn the skin, eyes, and mouth a yellow color.

Causes for high bilirubin levels include:

Prematurity - The more immature the liver is, the more likely it will not be able to adequately process bilirubin.

Bruising - Large bruises that occur during and after a difficult delivery can increase bilirubin levels, for example, bruising caused by forceps.

Infection - Babies that develop an infection or sepsis of the blood.

ABO/Rh Blood Incompatibility - When a mother and a baby have different blood types, the mother’s body produces antibodies that destroy the baby’s red blood cells, breaking them down and increasing bilirubin.

Race - East Asian babies have an inherently higher risk of developing jaundice.

Dehydration - Babies that have difficulty feeding or are not getting enough milk.

Treatments

Bilirubin is excreted from the body through the digestive system. The bilirubin moves through the liver and exits into the intestines as bile. The bile then goes through the intestines and leaves the body as stool. When the liver cannot keep up with this process, treatment options are available.

If a baby has signs or symptoms of jaundice, the doctor will order a blood test to check for the level of bilirubin in the blood. If the level is too high, treatment is required.

Jaundice Treatment Options Include:

Phototherapy - The baby will be placed naked on a warmer or in an isolette, only wearing a diaper. Protective eye covers must be used to prevent the light from causing damage to the eyes. The specialized light waves are absorbed through the skin and help to break down the bilirubin.

Bili blanket - A pad with internal phototherapy lights that can be placed around or under the baby.

Exchange Transfusion - If phototherapy is unsuccessful, removing the baby’s blood and replacing it with a blood transfusion will lower the levels of bilirubin.

If jaundice is not treated, serious complications can occur. High bilirubin levels can enter the brain and cause damage to the cells resulting in acute bilirubin encephalopathy, which can lead to brain damage, hearing loss, or developmental delay.

Helpful tips for parents

Medical care during pregnancy - If a mother has Rh-negative blood, the injection of a medication called Rhogam will help to prevent the blood from making antibodies that attack the baby’s red blood cells. It is important for expecting mothers to establish care with an OB-GYN as soon as she learns of the pregnancy. Problems like blood incompatibility will be identified, and treatment can be planned.

Monitoring the baby’s skin - Parents should monitor their baby’s skin, eyes, and the mucous membranes of the mouth to check for yellow discoloration. If signs of jaundice are present, parents should let their pediatrician know so that further assessment can be completed.

Feeding the baby - Parents should ensure that their baby is getting enough milk or formula. Breastfed babies should be placed on each breast for at least 10-15 minutes every 2-3 hours. Bottle-fed newborns should be offered 1-2 ounces of formula every 2-3 hours.

Monitoring for dehydration - Checking for wet diapers is another crucial factor in knowing that a baby is getting enough to eat and is not dehydrated. During the first and second days of life, newborns may only have a couple of wet diapers per day. Each subsequent day, the number of wet diapers should increase, and ideally, a newborn should have 6-10 wet diapers daily and 3 or more stools in a day.

Neonatal jaundice is common among newborns and does not always require treatment. If jaundice does not resolve on its own, phototherapy lights are an effective treatment option. If phototherapy is unsuccessful, an exchange blood transfusion may be necessary. Parents should monitor their baby’s skin and ensure it is getting enough to eat to prevent dehydration.