What is newborn jaundice. How common is jaundice in newborns. What causes jaundice in newborns. Which babies are at higher risk for jaundice. How to recognize jaundice symptoms. When to seek medical attention for jaundice. What are the potential complications of untreated jaundice.

Understanding Newborn Jaundice: A Common Condition in Infants

Newborn jaundice is a widespread condition affecting approximately 60% of newborns. It’s characterized by a yellowing of the baby’s skin and the whites of their eyes, caused by an accumulation of bilirubin in the blood. While jaundice often appears a few days after birth and is typically mild, it’s crucial for parents and caregivers to understand its causes, symptoms, and potential risks.

What exactly is bilirubin?

Bilirubin is a yellow substance produced when red blood cells break down. During pregnancy, the mother’s liver processes and removes bilirubin for the baby. After birth, the newborn’s liver takes over this task, but it may take a few days for it to function efficiently.

Common Causes of Jaundice in Newborns

The most prevalent type of jaundice in newborns is physiologic jaundice, which occurs in the first days of life due to the baby’s developing liver. However, several health conditions can also lead to jaundice:

• Blood type mismatches (e.g., Rh disease)
• Internal bleeding
• Liver problems
• Red blood cell abnormalities
• Genetic conditions (e.g., G6PD deficiency)
• Infections (e.g., sepsis)
• Birth-related bruising

Identifying High-Risk Factors for Newborn Jaundice

Certain factors can increase a baby’s likelihood of developing jaundice:

1. Premature birth (before 37 weeks of pregnancy)
2. Breastfeeding, especially if the baby is not feeding well
3. East Asian or Mediterranean ethnic backgrounds

Understanding these risk factors can help parents and healthcare providers monitor babies more closely for signs of jaundice.

Recognizing the Signs and Symptoms of Jaundice

Jaundice typically starts on the face and may spread to the chest, belly, arms, legs, and whites of the eyes. The best way to observe jaundice is in good lighting, such as daylight or under fluorescent lights. It’s important to note that jaundice can be more challenging to detect in babies with darker skin tones.

When should parents seek immediate medical attention?

Parents should contact their baby’s healthcare provider right away if they notice:

• Intense yellow, orange, or greenish-yellow coloration
• Difficulty waking the baby or excessive sleepiness
• Trouble breastfeeding or bottle-feeding
• Excessive fussiness
• Decreased wet or dirty diapers

In more severe cases, immediate medical attention (calling 911 or going to the hospital) is necessary if the baby:

• Has inconsolable crying or a high-pitched cry
• Arches backward
• Shows stiffness, limpness, or floppiness in their body
• Exhibits unusual eye movements

The Dangers of Untreated Severe Jaundice

While most cases of jaundice are mild and resolve on their own, severe untreated jaundice can lead to a serious condition called kernicterus. This type of brain damage is caused by extremely high bilirubin levels.

What are the potential long-term effects of kernicterus?

If left untreated, kernicterus can result in:

• Athetoid cerebral palsy (uncontrollable movements in various body parts)
• Hearing loss
• Vision problems
• Dental issues
• Intellectual disabilities

Fortunately, kernicterus is rare due to early detection and treatment of severe jaundice.

Jaundice Screening and Diagnosis in Newborns

The American Academy of Pediatrics (AAP) recommends that all newborns be screened for jaundice. This typically involves a visual assessment and, in some cases, a blood test to measure bilirubin levels. Many hospitals now use transcutaneous bilirubin (TcB) meters, which can estimate bilirubin levels without a blood draw.

How often should newborns be checked for jaundice?

The AAP guidelines suggest the following screening schedule:

• At least every 8-12 hours while in the hospital
• Before discharge from the hospital
• Within 48 hours after discharge
• Again between 3-5 days of age, when bilirubin levels typically peak

Treatment Options for Newborn Jaundice

The treatment for jaundice depends on the baby’s bilirubin levels, age, and overall health. Common treatment methods include:

1. Phototherapy (Light Therapy)

This is the most common treatment for newborn jaundice. The baby is placed under special blue lights that help break down bilirubin in the skin. This treatment can be done in the hospital or at home with portable phototherapy devices.

2. Enhanced Feeding

Increasing the frequency of feedings can help the baby pass more stool, which aids in removing bilirubin from the body. For breastfed babies, mothers may be advised to nurse more frequently. Formula-fed babies might need to increase their feeding amounts.

3. Intravenous Immunoglobulin (IVIG)

In cases where jaundice is caused by blood type differences between mother and baby, IVIG may be used. This treatment can reduce the need for an exchange transfusion.

4. Exchange Transfusion

In severe cases, where other treatments haven’t been effective, an exchange transfusion might be necessary. This procedure involves replacing the baby’s blood with donor blood to quickly reduce bilirubin levels.

Preventing and Managing Jaundice at Home

While not all cases of jaundice can be prevented, there are steps parents can take to manage mild jaundice and reduce its severity:

1. Frequent feeding: Ensure the baby is feeding every 2-3 hours, as this helps eliminate bilirubin through stool.
2. Proper hydration: Make sure the baby is getting enough milk or formula to stay well-hydrated.
3. Monitoring: Keep a close eye on the baby’s skin color and behavior, especially in the first week of life.
4. Sunlight exposure: Brief, controlled exposure to sunlight can help break down bilirubin. However, never place a newborn in direct sunlight, and always consult with your healthcare provider before trying this method.

Are there any home remedies that effectively treat jaundice?

While some traditional remedies exist, it’s crucial to note that there are no scientifically proven home remedies for treating jaundice. Always consult with a healthcare professional before attempting any home treatments.

Long-term Outlook for Babies with Jaundice

For the vast majority of newborns, jaundice is a temporary condition that resolves without any long-term effects. Most babies recover completely within 1-2 weeks. However, in rare cases where jaundice is severe or left untreated, there can be lasting consequences.

Does jaundice affect a baby’s development?

In most cases, jaundice does not impact a baby’s long-term development. However, severe untreated jaundice leading to kernicterus can cause developmental delays and other neurological problems. This underscores the importance of proper monitoring and timely treatment.

Regular follow-ups with the pediatrician are essential to ensure the baby is developing normally after recovering from jaundice. Parents should discuss any concerns about their child’s development with their healthcare provider.

Supporting Parents of Newborns with Jaundice

Having a newborn with jaundice can be stressful for parents. Healthcare providers play a crucial role in supporting families through this experience:

• Providing clear, accurate information about jaundice and its treatment
• Offering guidance on feeding techniques and frequency
• Ensuring parents understand when to seek medical attention
• Addressing parental concerns and anxieties
• Connecting families with support resources if needed

How can partners or family members support parents of jaundiced newborns?

Support from partners and family members can be invaluable during this time. They can help by:

• Assisting with feeding schedules, especially for night feedings
• Helping to monitor the baby’s condition
• Providing emotional support and reassurance
• Taking on household tasks to allow parents to focus on the baby’s care
• Accompanying parents to medical appointments for additional support

Remember, while jaundice is common and usually harmless, it’s essential to follow medical advice and attend all recommended check-ups to ensure the best outcome for the baby.

Newborn jaundice | March of Dimes

Newborn jaundice is when your baby’s skin and the white parts of his eyes look yellow. It’s caused by the build-up of a substance in the blood called bilirubin. Newborn jaundice is very common—about 3 in 5 babies (60 percent) have jaundice.

Jaundice usually happens a few days after birth. Most of the time, it’s mild, doesn’t hurt your baby and goes away without treatment. But if a baby has severe jaundice and doesn’t get quick treatment, it can lead to brain damage.

What causes jaundice in newborns?

Your baby’s body recycles some red blood cells each day. Bilirubin is a yellow substance that forms as red blood cells break down. During pregnancy, your liver removes bilirubin for your baby. After birth, your baby’s liver may not be developed enough to properly remove bilirubin on its own. It can take a few days for your baby’s liver to be able to do this.

When a baby’s liver causes jaundice in the first days of life, it’s called physiologic jaundice. This is the most common kind of jaundice in newborns. But sometimes a health condition in your baby can cause jaundice. Babies with these health conditions are more likely to need treatment to help lower their bilirubin levels than babies with physiologic jaundice. These conditions include:

• Blood type mismatches, like Rh disease. A small number of babies have different blood types than their mothers. These mismatches can lead to a faster breakdown of red blood cells.
• Internal bleeding. This is bleeding inside the body. 
• A problem with your baby’s liver. Your baby’s liver may not work well if he has an infection, like hepatitis, or a disease, like cystic fibrosis, that affects the liver. 
• A problem with your baby’s red blood cells. Some babies have too many red blood cells. This is more common in some twins and babies who are small for gestational age. This means a baby who is smaller than normal based on the number of weeks he’s been in the womb.  
• A genetic condition, like G6PD deficiency. This condition is when your body doesn’t have enough G6PD, an enzyme that helps your red blood cells work the right way. 
• An infection, like sepsis. This is an infection in your baby’s blood. 
• Bruising at birth. A bruise happens when blood leaks out of a blood vessel. Sometimes babies get bruises during labor and birth. When large bruises heal, bilirubin levels may rise. 

Some babies are more likely than others to have jaundice. These include:

• Premature babies. A premature baby is one who is born too early, before 37 weeks of pregnancy. A premature baby is more likely than others to have jaundice because his liver may not be fully developed.
• Breastfed babies, especially babies who aren’t breastfeeding well. If you’re breastfeeding, feed your baby when he’s hungry. For most newborns, this is once every 2 to 3 hours (about eight to 12 times each day). Feeding this often helps keep your baby’s bilirubin level down. If you’re having trouble breastfeeding, ask your baby’s provider, a nurse or a lactation consultant for help. A lactation consultant is a person with special training in helping women breastfeed. 
• Babies with East Asian or Mediterranean ethnic backgrounds. Ethnic background means the part of the world or the ethnic group your ancestors come from. An ethnic group is a group of people, often from the same country, who share language or culture. Ancestors are family members who lived long ago, even before your grandparents. 

How do you know if your baby has jaundice?

When a baby has jaundice, a yellowish color usually first appears on his face. It then may spread to his chest, belly, arms, legs and white parts of his eyes. The best way to see jaundice is in good light, like in daylight or under fluorescent lights. Jaundice can be harder to see in babies with darker skin.

Call your baby’s health care provider right away if your baby:

• Looks very yellow, orange or greenish-yellow
• Is hard to wake up or won’t sleep at all
• Has trouble breastfeeding or sucking from a bottle
• Is very fussy
• Has too few wet or dirty diapers 

Call 911 or take your baby to the hospital if he:

• Won’t stop crying or has a high-pitched cry
• Arches backward
• Has a stiff, limp or floppy body
• Has strange eye movements 

These may be warning signs of dangerously high levels of bilirubin that need quick treatment to prevent kernicterus. This is a kind of brain damage caused by high bilirubin levels. Kernicterus isn’t common because babies usually are treated before jaundice becomes severe. If untreated, kernicterus can cause:

• Athetoid cerebral palsy. Babies with this condition have uncontrollable movements in the arms, legs, face and other body parts.
• Hearing loss
• Vision problems
• Dental problems 
• Intellectual disabilities 

How are babies checked for jaundice?

The American Academy of Pediatrics (AAP) recommends that all babies be checked for jaundice after birth while in the hospital. Your baby’s provider checks her with one or more of these tests:

• Blood test. This is the best way to measure bilirubin levels. Your baby’s provider takes a small sample of blood from her heel to do this test.
• Physical exam. Your baby’s provider checks your baby’s body for signs of jaundice. 
• Skin test. Your baby’s provider places a device on your baby’s forehead to check her bilirubin level. The device measures the reflection of a special light that shines through her skin.

The AAP recommends that babies be checked for jaundice again at 3 to 5 days of age. This is the time when bilirubin levels are the highest. If your baby leaves the hospital before 72 hours (3 days) of age, she should be checked within the next 2 days.

How is jaundice treated?

Most babies with jaundice don’t need treatment. If your baby has mild jaundice, her provider may recommend that you breastfeed your baby more often so that she has more bowel movements. This helps to get rid of bilirubin.

Jaundice usually clears up within 2 weeks in formula-fed babies. It may last for more than 2 to 3 weeks in breastfed babies. If your baby’s jaundice lasts more than 3 weeks, talk to his health care provider.

If your baby has more severe jaundice, she may need treatment including:

• Phototherapy treatment (also called light therapy or bili lights). This is when your baby is placed under special lights that help her body change bilirubin into a form that she can get rid of in her urine. While she is under the lights, your baby wears just a diaper and shields over her eyes. Some babies can lie on a light therapy blanket (also called a fiber optic blanket) that has tiny bright lights in it. You may use the blanket in place of, or along with, the overhead lights. Phototherapy can be done in the hospital or at home, and it’s safe for your baby.
• Exchange transfusion. If phototherapy doesn’t work and your baby’s bilirubin levels are still very high, she may need a special type of blood transfusion called an exchange transfusion. An exchange transfusion gets rid of bilirubin by replacing your baby’s blood with fresh blood in small amounts.
• Intravenous immunoglobulin (also called IVIg). If you and your baby have different blood types, your baby may get immunoglobulin (a blood protein) through a needle into a vein. This can help her treat her jaundice so that she’s less likely to need an exchange transfusion.

See also: Premature babies

Last reviewed: April, 2013

Does My Baby Have Jaundice? What Are the Treatments?

Written by Rachel Reiff Ellis

In this Article

• What Is Newborn Jaundice?
• Causes
• Symptoms
• Diagnosis
• Treatment
• Newborn Jaundice Complications
• Newborn Jaundice Prevention

Newborn jaundice is a common and usually harmless condition in which your new baby’s skin and eyes look yellow. About 60% of babies get it.

Jaundice happens when too much bilirubin, a chemical that red blood cells release during their normal breakdown process, builds up in the blood. Sometimes it goes away on its own, or your doctor may suggest light therapy or other treatments to knock it out.

Some of the body’s red blood cells break down every day and create bilirubin in the blood. It’s the liver’s job to filter it out of the bloodstream. When your baby is still in your womb, your liver clears out their bilirubin for them. After birth, your baby’s liver takes over.

Sometimes, your newborn’s liver can’t break down bilirubin as quickly as their body makes it, and it starts to build up. Because bilirubin is a yellow compound, it turns your baby’s skin and eyes yellow. It can also happen if the bile ducts are blocked or scarred, a condition called biliary atresia. 

Babies have a greater chance of getting jaundice if they’re:

• Born before 37 weeks
• Of East Asian or Mediterranean descent
• Are exclusively breastfed or are having trouble breastfeeding or bottle feeding
• A younger sibling of a child who had jaundice
• Born to a mother with type O or Rh-negative blood

Jaundice typically shows up 2 or 3 days after your baby is born and goes away within the first couple of weeks. Some types may show up sooner or much later.

Breastfeeding jaundice happens because your baby isn’t eating enough. Your milk may not have come in yet or your baby is having trouble latching on. The more your baby eats, the more quickly their body clears waste, including bilirubin, from their system.

Breast milk jaundice appears after the first week. Doctors don’t know exactly why it happens, but they think something in breast milk keeps your baby’s liver from processing bilirubin effectively. This kind of jaundice can last for several months.

More serious kinds of jaundice are caused by a disease or condition, such as:

• Hemorrhage (bleeding) somewhere inside your baby’s body
• Infection of the blood (sepsis)
• Bacterial or viral infections
• Liver problems
• Lack of certain enzymes
• Problem with red blood cells that makes them break too easily

Jaundice may also happen if a mom has a different blood type from their baby. If that’s your situation, your body may make antibodies that attack and break down your baby’s red blood cells. In some cases, you can help prevent this by getting special shots when you’re pregnant.

The telltale sign of jaundice is a yellow color to your baby’s skin and yellow in the whites of their eyes. It typically starts on the face. Once bilirubin levels in the blood get higher, the yellow color moves to the chest and stomach, and then, finally, the legs and arms. Jaundice may be harder to notice on dark skin, so check the whites of your baby’s eyes and under your baby’s tongue to see if those areas look yellowish. 

Severe jaundice can be an emergency situation, so call your doctor right away if:

• Your baby isn’t eating or their diapers aren’t wet
• Your baby is hard to wake up
• Your baby won’t stop crying or is making a high-pitched cry
• Your baby is limp or stiff with their back arched
• Your baby’s eyes are moving strangely

Usually, a doctor can tell your baby has jaundice by looking. But they’ll also want to know how much bilirubin is in your baby’s blood to help decide on a treatment plan. They may:

• Take blood from your baby and send it to a lab to measure the level and kinds of bilirubin.
• Test your baby’s skin with an instrument that measures bilirubin by shining a special light on them.

If your doctor suspects that a condition is causing your baby’s jaundice, they may do other tests, like:

• A urine sample to check for infection
• A complete blood count to measure the number of red blood cells
• A reticulocyte count to see if the number of newly formed red blood cells is normal
• A blood type test to see if the mother’s blood is incompatible with the baby’s
• A Coomb’s test to see if the immune system is destroying the baby’s red blood cells
• A liver function test

In many cases, jaundice goes away on its own in 1 to 2 weeks. Your doctor will decide whether your baby should wait it out or start treatments like:

Extra feedings. Taking in more breast milk or formula will help your baby poop more often, which can help clear out bilirubin from the body. Or, if your baby is having trouble breastfeeding, your doctor may recommend you feed them breast milk from a bottle or also feed them formula.

Phototherapy. The doctor puts your baby under blue-green lights. It can help bilirubin leave their body in their urine. They’ll wear a diaper only so that most of their skin can soak up the light. They’ll wear patches to protect their eyes. The light may come from a special pad or mattress that puts out blue-green light.

Intravenous immunoglobulin (IVIg). If your baby’s jaundice happens because they have a different blood type from their mom, your doctor may need to give them a blood protein through an IV that helps stop the breakdown of red blood cells.

Exchange transfusion. If your baby has severe jaundice that isn’t getting better with other methods, they may need a blood transfusion called an exchange transfusion. In this process, your doctor repeatedly draws small amounts of your baby’s blood and replaces it with blood from a donor. Your baby will need to stay in the neonatal intensive care unit (NICU) for the procedure. It’s rare for babies to need this level of treatment for jaundice.

Don’t hesitate to get your baby checked if you notice signs of jaundice. It’s rare, but if severe jaundice is left untreated, bilirubin can enter the brain and cause permanent damage. This condition is called kernicterus, a complication that includes:

• Cerebral palsy
• Hearing loss
• Vision problems
• Seizures
• Developmental disabilities

There isn’t much you can do to prevent the typical jaundice in newborns. But you can help move it along by being sure your baby is well fed. If you’re breastfeeding, aim for 8-12 feedings a day in the first days of your baby’s life. If you’re formula feeding, offer 1-2 ounces every 2-3 hours. Exposing your baby to sunlight also helps break down indirect bilirubin.  Sit by the window indoors with your baby or take your baby for a stroll in the stroller if it is a nice day with sunshine. 

Top Picks

Newborn jaundice: causes, treatment, consequences, prevention

Newborn jaundice is faced by many parents. This is especially true for premature babies, but in babies who were born at term, this is also a common occurrence.

Jaundice develops in the first few days after the birth of the baby, and the change in skin color usually becomes noticeable on the 3rd-4th day, just when the mother and baby return home from the hospital.

Why does this happen and what is the difference between physiological neonatal jaundice, which does not require treatment, and dangerous pathological neonatal jaundice? We deal with doctors.

What you need to know about jaundice in newborns

Bilirubin is formed by the breakdown of red blood cells (blood cells that are responsible for transporting oxygen) throughout life and is excreted from the body without problems with the help of the liver. All body systems in a newborn do not work well enough, for example, the liver may not have enough enzymes to break it down and excrete it. Because of this, bilirubin accumulates in the blood, and the skin color becomes yellow. It happens that the whites of the eyes acquire the same shade.

Physiological jaundice differs from pathological jaundice in that the former does not require treatment and resolves on its own. This usually happens after the first month of a baby’s life. But the pathological condition is important and needs to be tracked in time. It affects the general well-being, has negative consequences, but with a competent approach, it is treated by a pediatrician or neonatologist.

Physiological jaundice – a variant of the norm	In the first days of life, many parents experience yellowing of the baby’s skin. At the same time, nothing threatens the condition of children, and the shade of the skin is normalized after 7-10 days. The only thing that can overshadow the first days of a baby’s life is vomiting. Occurs against the background of a bunch of bilirubin with albumin to prevent the toxic effects of the first (1). But such a phenomenon is rare.
There are several types of pathological jaundice	Conjugative jaundice develops due to liver enzyme deficiency. Hemolytic jaundice is associated with a change in the structure of red blood cells. And the problem of obstructive jaundice is a violation of the outflow of bile.
Things to pay attention to when treating jaundice (in addition to the general condition)	The doctor first of all specifies whether the child has prematurity and other factors that can complicate the course of the disease, whether there is a hereditary predisposition to this disease. It is worth paying attention to the appetite of the baby, and his mother, the level of lactation is also important.
There is a “bilirubin encephalopathy”	In this condition, bilirubin enters the child’s nervous system due to the fact that there is not enough albumin to neutralize it. The baby shows symptoms such as drowsiness, convulsions, and a weakened grasping reflex.
Jaundice is not contagious	It cannot be transmitted by airborne droplets. The cause of the disease is the increased breakdown of red blood cells and the insufficient functionality of the liver, which does not have time to process bilirubin secreted in large quantities.
When phototherapy is used for jaundice	At risk of hyperbilirubinemia, with physiological jaundice, with incompatibility of the baby’s blood type with the mother’s blood type, with an increase in bilirubin level above 5 µmol / l per hour.

How long does jaundice last in newborns

The duration of jaundice in a newborn depends on the characteristics of the organism. Physiological jaundice usually reaches its maximum on the 3-4th day of the baby’s life. Gradual fading begins on days 4-5, and on days 7-14, the child’s body completely copes with this condition.

– Parents are not always able to reliably determine whether the baby’s jaundice is normal or not. Therefore, this condition is given maximum attention by the medical staff (first in the maternity hospital, then on patronage), – explains Albina Yusupova, pediatric neonatologist Lahta Clinic . – Before discharge in the maternity hospital, doctors examine the child, determine the presence of jaundice, evaluate the skin color in dynamics, whether the yellowness of the skin / sclera increases or not. Often they resort to using a percutaneous method for measuring the level of bilirubin (it is he who gives such staining of the skin) or take blood for analysis. With high numbers, phototherapy is prescribed (a special lamp or mattress). There are no exact numbers for this, it depends on many factors: gestational age (term baby or not), the presence of cephalohematoma or bruising at birth, the color of feces / urine, whether there are concomitant pathologies or not, the blood type of the mother and child, how the mother eats and gains weight Baby.

In most cases, pathological jaundice develops on the first day of a newborn’s life. The duration may vary depending on the reason why the child suffers from this disease: sometimes the treatment takes 2 months, and in complex cases where enhanced therapy is required, jaundice can last up to a month.

Higher bilirubin levels have been reported in breastfed neonates with large postpartum weight loss (≥8%), diabetic mothers, low gestational age, and oxytocin drug induction of labor (2).

Causes of jaundice in newborns

Jaundice can appear in a baby for various reasons. Most often it is the accumulation of bilirubin in the blood. But there are other conditions that newborns face in the first weeks of life.

Bilirubin

Signs of pathology:

• deviations from the normal course of physiological jaundice (earlier or later appearance, prolonged persistence, undulating course),
• appearance of pallor or greenish tinge of the skin,
• increase in the concentration of total bilirubin in the blood serum,
• relative increase in the level of the direct fraction of bilirubin (3).

Unlike physiological, pathological jaundice, as a rule, develops in the first hours after the baby is born. There may be dark urine and discoloration of feces, anemia, and pale skin. At the same time, the level of bilirubin is very high:

• above 256 µmol / l in children born at term,
• above 171 µmol/l in preterm infants.

This condition is called hyperbilirubinemia. The most common cause of its development is hemolysis due to the incompatibility of the blood of the mother and child for erythrocyte antigens.

Other causes

“Pathological jaundice can be caused by several reasons,” says pediatrician Anna Levadnaya, MD, author of the blog about pediatrics . – The most common is an increased breakdown of hemoglobin due to an Rhesus conflict or a blood type conflict between mother and child. Also, the cause of jaundice can be a pathology of the liver or a pathology of excretion of bile into the intestines. In addition, jaundice can be a sign of an infection, hypothyroidism (due to a decrease in thyroid function), polycythemia (an increased level of red blood cells in the blood), intestinal obstruction, or pyloric stenosis (this is a congenital narrowing of the stomach before entering the intestines, which makes it difficult for food to pass through). into it). It can occur with certain medications and for other reasons.

Hepatic jaundice occurs when a child’s liver is exposed to viruses or bacteria. It can also develop with hepatitis B and hepatitis C, blood sepsis. At this time, the liver and spleen increase in size, the baby’s urine acquires a more pronounced color. Hepatic jaundice is treated comprehensively, primarily by acting on the cause.

Violation of the outflow of bile can cause obstructive jaundice. This happens when the patency of the bile ducts worsens due to malformations, underdevelopment, or the appearance of neoplasms. Here, all attention should be paid to the place where bile accumulates and the reason why it accumulates. After all, it is because of her that the baby may show symptoms of jaundice.

Another cause is neonatal cholestasis. To confirm the diagnosis, it is necessary to make sure that the content of the direct fraction of bilirubin in the blood is more than 15-20% of the total level, an increase in the concentration of cholesterol, beta-lipoproteins, bile acids, as well as alkaline phosphatase and gamma-glutamyltransferase enzymes (3). This pathology occurs due to an increased level of bile acid synthesis, for which the newborn’s liver is not ready. It happens that neonatal cholestasis occurs for reasons not related to the work of the liver. For example, against the background of hypoxia or the development of cardiovascular insufficiency.

There is also the so-called breastfeeding jaundice. There are studies that show that in healthy full-term infants who are bottle-fed, the level of bilirubin reaches a peak on the 5th day of life and becomes completely normal, on average, on the 13th day, while with natural feeding, two peaks of bilirubin rise are possible ( 3–5 and 10–15 days of life) with a gradual slow decrease (4). Jaundice from breast milk (from which certain hormones that increase bilirubin levels enter the baby’s body) can last up to 6 weeks.

If the doctor makes this diagnosis, he must exclude the presence of hyperbilirubinemia. Because breastfeeding jaundice cannot cause it. If, when HB is canceled for 1-2 days, bilirubin begins to decrease, and yellowness disappears, the diagnosis is confirmed. But with positive dynamics, the abolition of breastfeeding is not required: it is resumed after 1-2 days. During the pause, the mother must definitely express herself in order to maintain lactation at the required level.

Treatment of neonatal jaundice

Physiological neonatal jaundice, as we have already said, does not require treatment. Sometimes pediatricians recommend supplementing such children with water, but only if lactation is established and using a spoon, not a bottle.

As for the pathological jaundice of a newborn, it requires mandatory treatment, which is prescribed by a doctor.

Phototherapy is considered the most effective treatment for this condition. For this, a special lamp with blue light is used: under the influence of ultraviolet radiation, bilirubin breaks down and is excreted from the body of the newborn with urine and feces. The intensity and duration of phototherapy depends on the baby’s body weight at birth and the level of bilirubin, which is constantly monitored. As a rule, three-hour sessions under the lamp are prescribed with a break of 2-3 hours. The newborn must be undressed, but the eyes must be protected, the boys also have the genitals.

In severe cases of neonatal jaundice, when the life of the baby is at risk, a blood transfusion may be indicated.

Doctors have almost abandoned the use of drugs to treat neonatal jaundice. Some of them, for example, ascorbic acid and albumin, negatively affect the functioning of the nervous system, the effectiveness of allochol and B vitamins has not been proven, and Karsil and Essentiale have not been sufficiently tested specifically for newborns (3).

– It is important to note that most experts now agree that the appointment of sorbents, drugs such as phenobarbital, Essentiale, LIV-52, the abolition of breastfeeding, UV (ultraviolet blood enrichment), electrophoresis or excessive infusion therapy for jaundice is ineffective ( and it’s not safe for phenobarbital), says Anna Levadnaya.

Consequences of jaundice in newborns

Physiological jaundice in newborns, as we have already noted, goes away on its own and does not bear negative consequences for the health of the baby. But the consequences of pathological jaundice in a newborn can be extremely serious, especially if treatment is not started on time.

– Too high a level of bilirubin in the blood can lead to brain damage, – says Anna Levadnaya. – As a rule, this occurs in children with hemolytic disease according to the Rh factor, with an increase in the level of bilirubin above 298-342 µmol/l. And the higher the level of bilirubin, the higher the risk of encephalopathy.

Prevention of jaundice in newborns

The best prevention of jaundice in newborns is a healthy lifestyle for a mother during pregnancy, giving up bad habits, good nutrition.

In addition, the expectant mother must be tested for the detection of Rh-negative blood factor. Children born to mothers with Rh-negative blood are at risk for jaundice. After the birth of such babies, they carefully examine and monitor the content of bilirubin in the blood, and also determine the blood group.

– Women who may have a child with hemolytic jaundice are treated already during pregnancy. They are injected with anti-rhesus gamma globulin, and at birth, the child is immediately clamped on the umbilical cord and tested for bilirubin. If there are indications according to the tests, then the child is immediately put on phototherapy, – adds neonatologist Nadezhda Shurtakova . – The mother of the baby can also influence the fact that the child does not have jaundice. She needs to feed the baby more on the first day, try to get milk so that the baby does not lose weight. Jaundice often occurs with a large loss of initial weight. Bilirubin is a fat-soluble substance, and if the body of a newborn does not have enough fats, proteins and carbohydrates, then jaundice occurs at certain values ​​of body weight loss.

Mother’s milk is the best food for a newborn, it is easily digested, the intestines are stimulated faster, it is populated with beneficial microflora, the necessary enzymes are produced. All this helps the body of the newborn to cope with jaundice faster and more efficiently.

Frequently asked questions and answers

Nadezhda Shurtakova, neonatologist, head of the neonatal department at Maternity Hospital No. 4 (Moscow) answered frequently asked questions.

When is jaundice in newborns considered normal?

There are physiological and pathological jaundice. Physiological jaundice, which appears at the end of the second or third day of life, does not require treatment. Such jaundice is not pronounced and disappears on its own in 7-10 days. Physiological jaundice is present in 80% of children. Such children are discharged home without any additional examinations and treatment.

In what case is the child placed under the lamp and how long does the child need to stay there?

The child is placed under a lamp, for phototherapy, with pathological jaundice. The duration of therapy depends on what causes it.

Hemolytic jaundice of the newborn due to the Rh factor may appear already in the prenatal period, the child may be born with it and need an exchange transfusion. Such children are laid out under the lamp immediately at birth.

Jaundice caused by AB0 incompatibility (blood group incompatibility) appears at the age of 1.5 days. It is necessary to look at a biochemical blood test, and if there are indications, also put the child on phototherapy.

There is also conjugative jaundice, it, like physiological, also appears on the third day, but with it the amount of bilirubin (yellow substance) in the blood is significantly increased. Such children are also subject to phototherapy.

In different situations, phototherapy lasts from 1 to 4 days, usually 2-3 days, it is carried out under the control of biochemical and clinical blood tests. When the indicators are normal, the child is removed from phototherapy.

How long does it take to stay in the hospital if a newborn has jaundice?

Hemolytic jaundice lasts 5-7 days. We stabilize such children, wait for the end of the increase in bilirubin and then transfer them to another hospital. However, if treatment is started on time, the indicators return to normal faster, and the mother and child are already discharged from the hospital.

In case of conjugative jaundice, which may appear on the 4th day, already after discharge from the maternity hospital, children are admitted to hospitals from the districts.

Sources

1. E.I. Yulish. Jaundice syndrome in newborns: approaches to therapy // Health of the child. 2014. URL: https://cyberleninka.ru/article/n/sindrom-zheltuhi-u-novorozhdennyh-podhody-k-terapii
2. A.N. Goryainova. Jaundice in a healthy newborn: causes, course, prognosis // Medical Council. 2017. URL: https://cyberleninka.ru/article/n/zheltuhi-zdorovogo-novorozhdennogo-prichiny-techenie-prognoz
3. S. Ergieva. Jaundice of newborns // Vestnik VolGMU. 2007. URL: https://cyberleninka.ru/article/n/zheltuhi-novorozhdennyh/viewer
4. Gartner LM. Breastfeeding and Jaundice. J. Perinatol. 2001

Breastfeeding with jaundice | how to do it right

The experience of generations suggests that it is quite possible to cure the jaundice of a newborn only by sunbathing. After all, this is how our grandmothers and their grandmothers, and many people before us, were treated. The sunbathing method is old, so it seems tried and true. And mothers today do not see the need for phototherapy, believing that lying in the sun for a child will be much more useful than under the light of complex medical devices.

However, modern research shows that sunbathing is not only ineffective, it is also dangerous. Of course, it is possible to cure jaundice with their help, but only in theory. In practice, the child must be healthy as an ox to survive such therapy. Let’s see why.

Ultraviolet exposure

Many doctors recommend avoiding sun exposure even for adults, let alone a child. During sunbathing, not only useful, healing light, but also harmful ultraviolet radiation enters the skin. It is carcinogenic and causes cancer.

Unlike solar treatments, phototherapy involves the use of soft blue light, without any ultraviolet light. It best breaks down bilirubin molecules and is safe for the child.

Burns and overheating

Coming south, we try to avoid long exposure to the sun until the skin tans. However, we consider it normal to place the baby in direct sunlight as a treatment. Meanwhile, the delicate skin of a child is not yet able to defend itself from the aggressive effects of the heavenly body. Yes, and thermoregulation in a newborn is poorly developed. As a result, during “useful baths”, the baby will easily get burned or sunstroke.

Certified phototherapy equipment goes through many tests to ensure that the baby is safe. The thermal effect there is minimal, so burns are excluded, as well as overheating.

Unfortunate climate

Children are born all year round, and the climate in many places on the planet is far from sunny. In winter, the healing sun still needs to be caught. However, in summer the number of clear days also depends on the location of the windows, the weather. At the same time, the treatment of neonatal jaundice requires an almost continuous presence of the child in the light. To provide it with the help of sunbathing is simply impossible.

Restrictions on treatment time

Due to the risk of burns, heat stroke, harmful ultraviolet radiation, sunbathing should not be organized for longer than 15 minutes. But, even if it is possible to organize several sessions a day, this is not enough to cure jaundice. The minimum course is 96 hours, and the faster they pass, the less the risk of complications from elevated bilirubin. Phototherapy makes it possible to treat the baby with long sessions at any time of the day. At the same time, he is comfortable and calm.

Hypothermia and colds

Another risk of sunbathing is hypothermia. When lying in the sun, the child should be naked, which means that he can freeze. It is almost impossible to create a comfortable temperature during the procedure. But it is available to those who have chosen phototherapy: a heater can be placed near the lamp, and the device itself can be placed away from drafts and open windows.

Unpredictable effect

We cannot regulate the sun, so no one can guarantee the effectiveness of sunbathing. Sometimes the sun is too strong and burns the baby’s skin. On other days, on the contrary, it shines too weakly and does not help to remove toxic bilirubin. In general, even if the baby managed to lie in the sun 96 hours, no guarantee it will work. The photo lamp always shines in the same way with exactly the intensity that is needed. At the same time, its radiation is completely safe.

Discomfort for child and parents

Children do not like bright lights. Being under the sun, they cry, act up. Moms and dads also have to face inconvenience: they have to either bring the baby to the window, or rearrange the crib. Using a photo lamp, parents simply rock the baby in a special hammock, where he sleeps peacefully. The bed lamp is easy to move around the apartment, you can even take it with you to bed.

Complications and risk of hospitalization

Sunbathing is not effective enough, so the child needs additional treatment. As a rule, these are medicines, which, however, also do not always help to achieve the desired result. In the testimony of many, there is not even information that they can be used to treat neonatal jaundice. But there are side effects:

Why do doctors still use them? They follow outdated treatment standards that were developed in case the clinic did not have phototherapy lamps.