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Infant jaundice manifests as a yellowish tint in a newborn’s skin and eyes due to an excess of bilirubin, a yellow pigment found in red blood cells. This condition is prevalent, especially among preterm babies born before 38 weeks and some breastfed infants. The immature liver of a newborn often struggles to eliminate bilirubin effectively. Additionally, underlying diseases can contribute to infant jaundice in some cases.
Typically, infants born between 35 weeks’ gestation and full term do not require treatment for jaundice. In exceptional cases, an elevated concentration of bilirubin in the bloodstream can pose a potential threat of brain damage to a newborn, especially when specific risk factors for severe jaundice are present.
Symptoms
Jaundice is primarily identified by the yellow discoloration of a baby’s skin. The most noticeable changes are observed in natural light, such as sunlight streaming through a window, with the face being the initial area affected. The yellowing may extend to the whites of the eyes and the skin beneath the tongue. As bilirubin levels rise, the discoloration may progress to the chest, abdomen, arms, and legs. Detecting jaundice in babies with darker skin can be challenging, but it is still possible by examining the color of their eyes and the skin beneath their tongue.
Contact your doctor if you observe any of the following signs or symptoms, as they may indicate severe jaundice or complications arising from elevated bilirubin levels in your baby:
- Increased yellowing of your baby’s skin
- Yellowing of the whites of your baby’s eyes
- Yellow discoloration of the skin on the abdomen, arms, or legs
- Noticeable lethargy or difficulty awakening your baby
- Poor weight gain or feeding difficulties in your baby
- High-pitched cries from your baby
Causes
Infants generate higher amounts of bilirubin compared to adults, primarily due to increased production and quicker breakdown of red blood cells in the initial days of life. Jaundice occurs when there is an excess of bilirubin in the baby’s blood.
Jaundice resulting from natural conditions in newborns is termed physiologic jaundice and typically manifests on the second or third day of life. Other types of infant jaundice include breastfeeding jaundice and breast milk jaundice. Breastfeeding jaundice results from inadequate milk intake, while breast milk jaundice is linked to substances in the milk affecting bilirubin processing in the baby’s liver.
Jaundice can also be brought on by different illnesses or conditions:
- Sepsis, or a blood infection
- Additional bacterial or viral illnesses
- Internal hemorrhage or bleeding
- A malfunctioning liver
- Shortage of an enzyme
- Not the same blood type, or blood compatibility issue between the mother and the child
- A defect in the baby’s red blood cells that makes them degrade quickly
- Biliary atresia, a disorder characterized by the blockage or scarring of the baby’s bile ducts
- Excess in red blood cells
- Hypoxia, or low oxygen level
Compared to the more typical type of baby jaundice, jaundice due to underlying conditions frequently manifests significantly earlier or later.
Risk factors
Major factors that increase the risk of jaundice, especially severe cases with potential complications, include the following:
- Premature birth: Babies born before 38 weeks of gestation may process bilirubin more slowly than full-term babies. Premature infants may also have reduced feeding and fewer bowel movements, leading to lower bilirubin elimination through stool.
- Blood type discrepancy: When the mother’s blood type differs from the baby’s, the baby may receive antibodies through the placenta, triggering an accelerated breakdown of red blood cells.
- Birth-related bruising: Newborns who experience significant bruising during delivery may exhibit higher bilirubin levels due to the increased breakdown of red blood cells.
- Breastfeeding: Breastfed infants, particularly those facing challenges in nursing or obtaining sufficient nutrition, are at a higher risk of jaundice. Dehydration or inadequate caloric intake can contribute to jaundice onset. Despite these risks, experts still recommend breastfeeding, emphasizing the importance of ensuring the baby receives enough nourishment and stays adequately hydrated.
- Race: Studies indicate that infants of East Asian ancestry have an elevated risk of developing jaundice.
Diagnosis
Diagnosing infant jaundice is primarily based on the visual assessment of your baby’s appearance, but it is essential to quantify the bilirubin levels in their blood for an accurate diagnosis. The severity of jaundice, determined by bilirubin levels, guides the treatment plan. Diagnostic methods include:
- Physical examination
- Laboratory testing using a blood sample from your baby
- Skin testing with a transcutaneous bilirubinometer, which measures light reflection through the skin
If there are indications of an underlying disorder contributing to the jaundice, your doctor may also order additional blood or urine tests.
Treatment
Mild jaundice in infants typically resolves on its own within two or three weeks. For cases of moderate or severe jaundice, extended hospital stay or readmission may be necessary.
Addressing elevated bilirubin levels in your baby might involve the following interventions:
- Enhanced nutrition: To prevent weight loss, your doctor may recommend more frequent feeding or supplementation to ensure your baby receives sufficient nutrition.
- Light therapy (phototherapy): Placing your baby under a special lamp emitting blue-green light can alter the structure of bilirubin molecules, facilitating their excretion through urine and stool. During this treatment, your baby will wear only a diaper and protective eye patches. Light therapy may also involve the use of a light-emitting pad or mattress.
- Intravenous immunoglobulin (IVIg): If jaundice is linked to blood type differences between the mother and baby, where antibodies from the mother contribute to the rapid breakdown of the baby’s red blood cells, an intravenous transfusion of immunoglobulin may be administered. This blood protein can reduce antibody levels, potentially decreasing jaundice and minimizing the need for an exchange transfusion, although conclusive results are not guaranteed.
- Exchange transfusion: In rare cases where severe jaundice does not respond to other treatments, a baby may undergo an exchange transfusion. This procedure, conducted in a newborn intensive care unit, involves withdrawing small amounts of the baby’s blood and replacing it with donor blood. This dilutes bilirubin and maternal antibodies, aiming to address the persistent jaundice.
