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Jaundice in newborns

Alternative names

Jaundice of the newborn; Physiologic jaundice of the newborn

Definition
Newborn jaundice is a condition caused by increased levels of bilirubin (a byproduct of the normal breakdown of red blood cells by the liver) which gives an infant's skin and eyeballs a yellowish tinge.

Causes, incidence, and risk factors    Return to top

At birth, babies have a relatively immature liver function. Therefore, jaundice is present to some degree in almost all newborns. Even the normal destruction of red blood cells by the liver in the newborn infant can cause jaundice. This form of jaundice usually appears between the 2nd and 5th days of life and clears by 2 weeks. It usually causes no problems.

Breast-feeding jaundice is seen in 5-10% of newborns. It is similar to physiologic jaundice, but bilirubin levels tend to be slightly higher. This occurs when breast-fed babies do not take in enough breast milk and rarely requires treatment.

Sometimes, however, breast-feeding does need to be interrupted and bottle-feeding substituted for a brief period of time to clear the jaundice.

Jaundice in a newborn is rarely caused by a serious illness. Disorders which can cause jaundice in a baby include:

biliary atresia
ABO incompatibility (similar to a transfusion reaction, caused when fetal and maternal blood mingle before birth)
Rh incompatibility (Anti-Rh antibodies)
galactosemia (see galactosemia screen)
cephalohematoma
polycythemia
glucose-6-phosphate dehydrogenase deficiency
neonatal sepsis
congenital cytomegalovirus infection (CMV)
congenital toxoplasmosis
congenital syphilis
congenital herpes
congenital rubella
congenital hypothyroidism
late pregnancy administration of sulfa drugs to the mother
Crigler-Najjar syndrome
spherocytosis (congenital hemolytic anemia)
cystic fibrosis
pyruvate kinase deficiency
thalassemia
Gilbert's syndrome
Lucey-Driscol syndrome
Gaucher's disease
Niemann-Pick disease


Symptoms
yellow color of the skin
poor feeding (may be present)
lethargy (may be present)

Signs and tests
elevated serum bilirubin level

Treatment for jaundice

Treatment is usually unnecessary. In all cases, it is important to keep the baby well-hydrated (breast milk and formula are preferable to glucose water) and encourage frequent bowel movements by feeding frequently. This is because broken down bilirubin is carried out of the body by the intestines in the stools (bilirubin is what gives stool their brown color).

Sometimes artificial lights are used on infants whose levels are very high, or in premature infants. These lights work by helping to break down bilirubin in the skin. The infant is placed naked under artificial light in a protected isolette to maintain constant temperature. The eyes are protected from the light.

In the most severe cases of jaundice, an exchange transfusion is required. In this procedure, the baby's blood is replaced with fresh blood. Recently, promising studies have shown that treating severely jaundiced babies with intravenous immunoglobulin is very effective at reducing the bilirubin levels to safe ranges.

Expectations (prognosis)

The jaundice usually resolves without treatment within 1 to 2 weeks.
Complications    Return to top

Kernicterus, brain damage from very high bilirubin levels is rare. Other rare, but serious, complications from high bilirubin levels include deafness and cerebral palsy.


Calling your health care provider

Call the infant's health care provider if jaundice is severe (the skin is bright yellow), if jaundice lasts longer than 1 or 2 weeks, or if other symptoms develop. Jaundice is an emergency if the baby has a fever, has become listless, or is not feeding well.


Prevention
In newborns, some degree of jaundice is normal and probably not preventable. Prevention of disease-related jaundice is related to the specific disease.

Since babies are now sent home from the hospital quickly or are often born in settings like birthing centers, it is important for parents to be on the lookout for jaundice in their infants in the first few weeks of life.


Update Date: 7/26/2002

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites.

http://www.nlm.nih.gov/medlineplus/ency/article/001559.htm

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