Our bodies are incredible things that operate on both the grand and the atomic scale in a multitude of ways to keep us alive. Even newborns are born already doing incredible things to adjust to a world that is completely different from the warmth of the womb. One minute the baby is contained in a protective uterus and getting all his nutrients from the mother through the placenta, and just a short time later he’s taking in that monumental first breath, which sets in motion a whole cascade of other physiological and neurological responses. It can take a while for all systems to come fully on board, but very quickly newborns are not only surviving but often thriving with basic care.
The majority of parents give birth to healthy newborns–who also often develop jaundice after a few days. For parents who feel like they’re giving the best care, seeing jaundice develop can be a little worrisome, but it’s a condition that many parents encounter in their newborns in the first week of life. Even though it’s a relatively common issue, many parents don’t understand what is happening when jaundice is observed and diagnosed. Fewer still are aware of all the factors that can cause jaundice to appear–and why the therapies that doctors describe or recommend work. There are even some rare but serious conditions that can cause jaundice or result from untreated jaundice. For parents who just want to know: here is your crash course on jaundice.
It’s In The Blood
Every human being is a recycler before they can even grasp the concept. Red blood cells have a life expectancy, and when they’re old the body breaks them down into other elements to be used elsewhere in the body or excreted. Bilirubin is a yellowish-pigmented end product of this recycling process, according to Encyclopaedia Britannica.
It then enters the bloodstream until it cycles through the liver, which packages it up to be excreted. When baby is born, her liver might not be mature enough, or may initially be a little slow to process waste in her system, leading to a buildup of unconjugated–meaning free-roaming–bilirubin in the blood, explains the Mayo Clinic.
A Common Condition
Many healthy, full-term newborns develop mild jaundice in the first few days after birth. Newborn jaundice is so common that as many as 60% of all babies show signs of jaundice, according to the March of Dimes. Most cases of jaundice are physiologic, meaning that they are caused by a liver that has not caught up with processing bilirubin yet.
While it’s incredibly common for perfectly healthy babies to develop mild jaundice, it rarely poses a threat and causes no damage or injury to the baby. It usually requires minimal to no treatment. Babies may have jaundice that is so mild it’s difficult to detect, due to darker complexions. Breastfed babies are far more likely to develop jaundice than formula-fed newborns.
A Yellow Fellow
The first and best indication that parents and doctors notice in a newborn with jaundice is the distinctive yellowish cast to the skin. If the jaundice is mild enough, then it might not be obvious until gentle pressure is applied to the skin with a fingertip and then removed, as per Family Doctor.
The distinctive yellowing of the skin might be more difficult to detect in babies with darker skin tones, but the whites of the eyes and the inside of baby’s mouth can help with detection. The reason babies turn yellow is because of the buildup of bilirubin the blood. Bilirubin is a yellowish-brown pigmented byproduct of old red blood cells–and it’s the same thing that colors stool.
In The First Week
Once a baby is born, a lot of organs and systems come online when she leaves the womb and is separated from the umbilical cord and placenta, which have regulated her developing systems up until this point. Jaundice can begin to develop within 24 hours, but is often not evident until two to four days after birth, according to Medline Plus.
Newborn red blood cells have a shorter life expectancy than those of adults. Babies are often born with a storehouse of hemoglobin, so the first week of life sees a buildup of blood that has to be processed by a liver that may not be fully developed–and all this leads to an excess of bilirubin, explains Science-Based Medicine.
The Usual Suspect
Despite the sometimes yellow or orange cast to baby’s skin, most cases of jaundice are mild and not dangerous to baby. The most common form of jaundice is physiological jaundice–also called normal jaundice–and is simply a matter of a slightly immature liver function, according to KidsHealth.
This can happen even in perfectly healthy babies born at full-term, whether breast- or formula-fed. Breastfed babies can also develop jaundice either because they aren’t initially getting enough breastmilk, or because of a substance in the breastmilk. Usually breastmilk-related jaundice can be resolved when mom’s milk comes in or with the assistance of a lactation consultant. Premature babies frequently develop jaundice because their liver has had even less time to mature.
A rarer form of jaundice develops in babies who are fighting off sepsis, a serious bacterial infection that can quickly overwhelm the immune system. For years, doctors have wondered why evolution allows for so many babies to develop jaundice when the accumulated bilirubin had the potential to cause brain damage in high concentrations and it seems to have no benefit towards the baby’s health in the first few days.
Recent research has given more credence to the theory that even modestly high levels of bilirubin in the bloodstream can reduce the growth of the bacteria most commonly associated with sepsis in newborns, essentially helping the baby fight for his life against often fatal sepsis, according to The Conversation.
The Liver’s Tiny Tubes
Physiological jaundice usually makes its presence known within the first week of a newborn’s life, but jaundice that appears after the second week up until two months of age may be related to a very rare but serious liver disease, as per St. Louis Children’s Hospital.
In biliary atresia, jaundice is just one of the symptoms caused by blockages in the bile ducts of the liver. When these ducts are blocked, it can cause permanent liver damage as bile backs up inside the liver. Doctors don’t know exactly what causes biliary atresia, but if baby’s jaundice doesn’t respond to common therapies, doctors will usually run tests to determine whether the jaundice is caused by an infection or by biliary atresia.
A Preponderance In The Premature
Premature babies are far more likely to develop jaundice in the first few days after birth. Their livers are less likely to be developed enough to deal with the bilirubin that is produced when red blood cells are broken down. Even premature babies usually avoid the worst complications of jaundice–called kernicterus–which can cause permanent neurological damage, according to Verywell Family.
Because premature births are more likely to be accompanied by medical intervention such as vacuum or forceps extractions, preemie babies are more likely to suffer bruising or internal bleeding that can also cause an excessive buildup of bilirubin. Premature babies are watched carefully for signs of jaundice and often are prescribed phototherapy while in the hospital as a precaution.
A less common reason for infant jaundice is when the jaundice is a result of mom and baby either having different blood types, or when mom is Rh negative and baby is Rh positive, according to Duke Health.
A blood type incompatibility between mom and baby happens when mom has O type blood, but her baby has A or B type blood. This disparity in blood types doesn’t guarantee that jaundice will occur, but if mom’s antibodies have gotten into baby’s system, then it could happen. Rh factor is determined by the presence or absence of the rhesus antigen on the red blood cell, as per Medicine Net. Around 85% of the population is Rh positive, although Rh factor jaundice is rare.
A G6PD Deficiency
G6PD deficiency is rare and has over 400 expressed variations, but has been linked to severe infant jaundice, according to G6PD Deficiency Favism Association. This inherited deficiency is carried on the X chromosome and is most prevalent in parts of Africa and in Mediterranean populations.
Because jaundice is a common condition and usually requires no treatment and G6PD deficiency is relatively rare, infants who haven’t been identified as having the deficiency are especially at risk for developing complications like kernicterus, which can cause permanent neurological damage. Mothers may be healthy carriers and pass the gene on to their sons. The G6PD deficiency may mean that as the baby grows, he’ll need to avoid certain foods and substances.
At The Beginning Of Breastfeeding
There are two kinds of jaundice related to breastfeeding. The more common form occurs when baby isn’t feeding well. The newborn might be struggling to nurse because mom’s milk is slow coming in, because mom is restricted from breastfeeding, or because the baby is having difficulty in latching on correctly, as per Children’s Hospital of Philadelphia. Frequent nursing helps to eliminate jaundice faster, because breastmilk has a laxative effect, and this sends bilirubin out through baby’s diaper.
Better breastfeeding support can reduce the incidence of this type of jaundice in newborns. Another form of jaundice can occur in well-established breastfeeding, as per Science Based Medicine. It’s believed that some substance in the breastmilk that causes the mild form of jaundice.
The Brain On Bilirubin
Most cases of jaundice come and go with no lasting effects on baby, but occasionally the levels of bilirubin can build up to such a high level that the bilirubin begins to move out of the blood into the brain tissue. When this happens, baby is often excessively tired to the point that he can’t be woken or kept awake, as per Children’s Mercy Kansas City.
When bilirubin levels are this high, babies are diagnosed with kernicterus, and often suffer irreversible brain damage. Other symptoms of kernicterus are hypotonia–a ragdoll-like floppiness–and arching the back. If kernicterus symptoms are apparent, then brain damage is happening, but high bilirubin levels can be treated effectively before the onset of the symptoms.
Uncovering The Culprit
Parents can check at home for jaundice by gently pressing the skin with a fingertip and looking for the tell-tale yellow undertone, or can look at the whites of baby’s eyes or the inside of her mouth. If it’s not easy to tell, or if baby has other symptoms of high bilirubin levels like lethargy, doctors can run tests to determine the actual bilirubin levels, according to NHS.
A bilirubinometer can calculate levels by shining a light off the skin, or a heel prick test can check blood levels directly. The less-invasive bilirubinometer is usually used first since more serious causes of jaundice are rare. Other blood tests can be done to rule out blood type or infection related jaundice.
Come To The Light Therapy
Babies with moderate to high levels of bilirubin can be effectively treated with phototherapy. The baby is placed undressed as much as possible in a bassinet and exposed to artificial light, as per HealthLink BC. A little mask is placed over baby’s eyes to protect the retinas.
While phototherapy isn’t very invasive and is very effective, it’s not totally risk-free. The newborn is at risk for dehydration if he isn’t staying on a nursing or feeding schedule, and he could develop a skin rash or have trouble regulating his body temperature. Doctors might treat baby in the hospital or parents may be able to treat baby at home, and his bilirubin levels will be checked until the jaundice subsides.
Antibodies And Immunoglobulins
When mother’s immune system creates antibodies to baby’s different blood type, those antibodies can cross over into the immune system of the fetus. Once they cross the placenta, they begin destroying red blood cells and can cause anemia in the baby, but after birth, the persistence of the antibodies will cause a spike in bilirubin, which often shows up as jaundice, according to Cochrane.
The first line of defense even for this kind of jaundice is still phototherapy. If the bilirubin levels are dangerously high then doctors sometimes consider other procedures like an exchange transfusion or intravenous immunoglobulin. Exchange transfusions are considered fairly risky, so usually aren’t the first choice, but may be considered in conjunction with phototherapy.
Feed Me, Mommy
Sometimes jaundice occurs when mom and baby get off to a rocky start while breastfeeding, but the best route to go is to check in with a lactation consultant who can help to pinpoint the difficulties and make breastfeeding more productive. Most experts will encourage moms to continue breastfeeding to help lower the levels of bilirubin, explains the Centers for Disease Control (CDC).
Once milk has come in and baby is getting a good latch, frequent feedings will encourage good bowel movements and keep baby well-hydrated, which helps baby to expel the bilirubin. The only time that baby might be better off with a short break from breastfeeding is if he is one of the rare cases of breastmilk jaundice.
Watch For The Change
Most parents go home with baby soon after giving birth, so often jaundice begins developing at home–not in front of the doctor. While parents are certainly sure to be tired and maybe even overwhelmed with the huge change in their lives, they are the first line of defense when it comes to awareness of jaundice and how to care for baby, as per Science-Based Medicine.
Parents are looking at baby the most, and can monitor her eyes and skin. Some cases of jaundice aren’t as apparent in the skin, but if baby is unusually tired or lethargic or doesn’t rouse easily, it’s better to call the pediatrician before the next checkup, even if it’s only a day away.
Go Baby Glo
Even if baby only has mild jaundice, that mustard-yellow color can be disconcerting to parents, who wonder how long their newborn is going to have that Day-Glo sheen. Most mild cases of jaundice peak within a week, and have gone away within two weeks, according to BabyCenter.
Some babies can have a yellow tint for up to two months, especially premature babies. It can be frustrating for parents, but frequent breastfeeding and light therapy will help resolve the situation much more quickly. Jaundice is usually first seen in baby’s face, and may move downwards throughout the body from there–or not. Breastmilk jaundice, which often becomes evident after the first week, may last for months.
The Old-Fashioned Remedy
Not so long ago, mothers of newborns with jaundice were told to just sit with baby near a sunny window or to take baby out for a short walk. Parents were advised to expose baby to sunlight for no longer than 15 minutes several times a day, as per Ask Dr. Sears.
The sunlight helps the bilirubin dissolve and move out of the bloodstream so baby can urinate it out. Sunlight can be safe so long as baby isn’t exposed for long periods of time. If sunlight is filtered by a plastic sheet to reduce ultraviolet and infrared light, it’s safe for longer periods of time and more effective than the artificial light of phototherapy, according to the New York Times.
Sources: Encyclopaedia Britannica, Mayo Clinic, March Of Dimes, Family Doctor, Medline Plus, Science Based Medicine, Kids Health, The Conversation, St. Louis Children’s Hospital, Verywell Family, Duke Health, Medicine Net, G6PD Deficiency Favism Association, Children’s Hospital Of Philadelphia, Children’s Mercy Kansas City, NHS, HealthLink BC, Cochrane, Centers For Disease Control, BabyCenter, Ask Dr. Sears, New York Times