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Jaundice

Newborn with Jaundice
What is jaundice?

Jaundice is a condition causing the skin, body tissues, and fluids to have a yellowed color. You often see the color on the skin or white parts of the eye. The yellow color is caused by a build up of bilirubin in the blood. Bilirubin is a pigment released into the blood when red blood cells are broken down.

Jaundice is common in newborns. This is because all newborn babies are born with more red blood cells than they need. These extra red blood cells break down, releasing  bilirubin into the blood.

It is normal for newborns to have jaundice in the first few days of life. It is usually harmless. 

A newborn may have abnormally high levels of bilirubin in their blood because of the following:

  • Infection, metabolic imbalances, or other conditions can make red blood cells easy to break down.

  • Liver, intestinal, or gut problems can cause the body to get rid of bilirubin more slowly than usual. This kind of delay can also be caused by certain drugs.

  • In newborns, bilirubin is absorbed back into the blood from the gut before the body gets rid of it. In newborns who do not feed very well, more bilirubin is reabsorbed. This is the most common reason for jaundice in newborns.

What if I am told my baby has breastfeeding or breastmilk jaundice?

You might hear some people talk about breastfeeding jaundice or breastmilk jaundice. These are confusing terms. Some jaundice may be associated with breastfeeding. This is normal and generally not harmful to the baby.

It is always good to breastfeed your baby as much as possible. The Canadian Paediatric Society and other paediatric associations recommend breastfeeding for at least 6 months after your baby is born. In some cases, babies and moms need help with breastfeeding and feeding in general. Your doctor, a lactation consultant, or a nurse can help you with questions or problems about feeding.

Signs and symptoms of jaundice

Jaundice makes the baby’s skin and eyes have a yellowed color. It may make the baby feel sleepy and make it harder for him to feed well. The baby’s stools may remain black or dark for a longer time after birth than in a newborn without jaundice.

What your doctor can do for a baby with jaundice

Your doctor will physically examine your baby and confirm the diagnosis with a simple test to check the level of bilirubin. Your doctor will then decide on the best way to care for your baby based on this test result. The age and birth weight of your baby are also important.

When you and your baby leave the hospital, your doctor or nurse will explain what you need to do to help your baby.

If the test suggests that your baby has a high chance of getting to a level of bilirubin that needs more treatment, your doctor will arrange a follow-up visit. Someone else will examine and test your baby.

If the doctor thinks that there may be a more complex reason for the jaundice, he or she may decide to do extra tests.

Complications of jaundice

Some babies need treatment to stop the jaundice from getting too severe.

A very small number of babies with severe jaundice can develop a condition called kernicterus (say: ker-NICK-ter-us). This is rare. Kernicterus can lead to lasting brain damage and hearing loss.

Treatment for jaundice

Phototherapy (light treatment)

Phototherapy means "treatment with light." A doctor or nurse will undress your baby, protect his eyes and expose him to a special light.

Your baby's skin and blood absorb the light waves. The light changes the bilirubin to a form that is water-soluble, so the body can get rid of it more easily.

There is also a product called a “BiliBlanket." This is another way to treat the baby's jaundice with light. The blanket is a flat pad with a jacket that goes around the baby. It is attached by a long grey hose to a special machine. The machine makes the pad light up.

These treatments are completely safe.

Side effects of phototherapy

Babies may have frequent and loose bowel movements (stools) that are sometimes greenish in color. This is normal, since the body gets rid of bilirubin in the stools. This side effect should stop when the treatment is finished.

Babies receiving phototherapy will also be monitored so that they do not become dehydrated. Some babies may need extra fluid through an intravenous line (IV).

Prevention of jaundice

Feed your baby often, especially breastfeeding, in the first hours and days after birth. This helps reduce the risk of serious jaundice. Feeding helps your baby pass more stool. Milk gives your baby’s liver the energy it needs to get rid of the bilirubin.

When to see a doctor

Make an appointment with your baby’s regular doctor if:

  • your baby appears jaundiced (yellow)

  • your baby appears more lethargic or inactive

  • your baby is not feeding well or showing signs of dehydration

Go to the nearest Emergency Department or call 911 if:

  • your baby is extremely lethargic or inactive

  • your baby is vomiting (throwing up)

  • your baby has a fever

  • you are concerned that the jaundice is getting worse and your doctor is not available

Key points

  • Get medical help the same day if your baby appears to be getting more jaundiced.

  • Breastfeed your baby.

  • If your newborn’s feedings are not going well, seek medical help the same day.

  • If you are asked to come back after leaving the hospital to recheck your baby’s bilirubin or jaundice level, follow instructions carefully.

Carole P. O'Beirne, MSc, MD, FRCPC
Janine A. Flanagan, HBArtsSc, MD, FRCPC

3/5/2010




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