Understanding Jaundice in Newborn Infants

Jaundice is a very common condition in newborn babies. The term jaundice refers to a yellowing of the skin that results from high levels of a pigmented compound called bilirubin. All newborn infants naturally have bilirubin levels higher than those found in adults. However, only some of these infants will develop levels high enough to manifest as jaundice.

Fortunately, jaundice is generally a benign condition that resolves with time. Jaundice begins to clear when the neonate's liver starts to effectively metabolize bilirubin and he or she begins to move some of the bilirubin out with each bowel movement.

How do you tell if your baby is jaundiced?

Jaundice is more common in dark skinned infants. However, it is also difficult to actually see the yellowing in a baby with pigmented skin. Jaundice is best detected by firmly pressing on the baby's skin with your finger and then observing the coloration of the skin when you let up the pressure.

A general rule of thumb is that jaundice starts in the face first. As the levels of bilirubin increase the yellowing begins to involve more of the infant's body, the face and chest, then face, chest and stomach, and eventually the whole body.

If the bilirubin levels remain high for a sustained period of time babies may also develop scleral icterus which is a yellowing of the whites of the eyes.

Is jaundice harmful to the newborn infant?

Many cases of jaundice are quite harmless and are referred to as physiologic jaundice. Often, this form of jaundice does not become apparent till 2 to 3 days after birth. Whether or not an infant requires treatment (usually in the form of phototherapy lights) is determined by measuring the actual level and specific type of bilirubin and plotting on a risk assessment chart that is used for all cases of high bilirubin ("hyperbilirubinemia") in infants.

Jaundice that occurs within 24 hours of birth is always referred to as pathologic jaundice. This term refers to a process occurring in the infant's body which is not the result of normal neonatal physiology. While any jaundice within 24 hours of life is pathologic, other causes of pathologic jaundice can manifest after this time period. As mentioned previously, your physician will always consider the level of bilirubin and type of bilirubin (conjugated or unconjugated). Depending on these results he or she may run additional tests to evaluate for blood type incompatibility, gastrointestinal problems, hepatitis, etc.

What should you do if you notice jaundice in your baby?

Always, always, always tell your pediatrician if you notice that your baby's skin has become yellow. This may be normal physiologic jaundice of the newborn, or if the baby is a few weeks old and feeding well this may be breast milk jaundice (though this is less common). However, it is absolutely necessary to ensure that this is not pathologic jaundice. Extremely high levels of bilirubin can result in a condition called kernicterus. This condition results in severe and often permanently devastating physical and mental health problems for your child.