Infant Jaundice




Introduction

Infant jaundice itself isn't a disease. In most cases infant jaundice occurs because your baby's liver isn't mature enough to metabolize a molecule called bilirubin, which normally forms when the body recycles old or damaged red blood cells.

During their first few days of life, more than half of all full-term babies and as many as four out of five premature infants who are otherwise healthy develop jaundice, a yellowish discoloration of the skin and eyes. Although some babies are jaundiced at birth, most develop infant jaundice during their second or third day of life. That's why you may not notice it until after your baby is home.

Infant jaundice usually isn't a cause for alarm. It doesn't cause discomfort for your baby, and it usually disappears on its own in one to two weeks. Still, infant jaundice should be closely monitored by your baby's doctor because severe jaundice can lead to serious complications. Treatments can help keep your baby's blood level of bilirubin from becoming too high.

Signs and symptoms

In most babies, signs of infant jaundice appear in the second or third day of life and include:
  • Yellowing of the skin
  • Yellowing of the eyes
You'll usually notice jaundice first in your baby's face. Later, his or her chest, abdomen and legs also may turn yellow. An easy way to test for infant jaundice in a baby of any race is to gently press your finger on your baby's forehead or nose. If the skin looks yellow where you pressed, it's likely your baby has jaundice. It's best to examine your baby in natural daylight. In addition to checking for yellow skin, note whether the whites of your baby's eyes also are yellow.

Infant jaundice commonly lasts for a week to 10 days in full-term newborns. If your baby is premature or if you breast-feed your baby, jaundice may last longer.

Causes

Babies are born with a generous supply of red blood cells, which help transport oxygen. Over time, these red blood cells break down, forming bilirubin in the process.

Bilirubin is normally transported to the liver, where it's processed before being eliminated from the body. But newborns initially have more bilirubin than their livers can handle, and the excess causes their skin and, sometimes, the whites of their eyes to turn yellow. This type of jaundice, called physiologic jaundice, typically appears on the second or third day of life.

Although any newborn can develop physiologic jaundice, it occurs more often, and is sometimes more severe, in premature babies because their livers are even less developed than are those of full-term infants.

Sometimes a baby may develop jaundice for other reasons. If jaundice is present at birth or appears within 24 hours, it may be the result of:
  • Severe bruising
  • An infection in your baby's blood (sepsis)
  • An incompatibility between your blood and your baby's
Jaundice that develops in or lasts past the second week of life may be due to:
  • A liver malfunction
  • A severe infection
  • An enzyme deficiency
  • An abnormality of your baby's red blood cells
Complications

Left untreated, severe jaundice can lead to a rare, but very serious, condition called kernicterus (hyperbilirubinemia). With kernicterus, extremely high levels of bilirubin can cause damage to a newborn's brain and may lead to deafness, severe developmental disabilities and an unusual form of cerebral palsy. Prompt treatment of jaundice can keep kernicterus from developing.

Especially if your baby was born early, be watchful for signs and symptoms of severe jaundice, such as:
  • Deep yellow or orange skin tones
  • Extreme sleepiness so that it's hard to wake your baby
  • High-pitched crying
  • Poor sucking or nursing
  • Weakness or limpness
See your doctor right away if you notice any of these signs and symptoms in your newborn.

Treatment

Mild infant jaundice often disappears on its own within a week or two. But if your baby has moderate or severe jaundice, he or she may need to stay longer in the newborn nursery or be readmitted to the hospital. Treatments to lower the level of bilirubin in your baby's blood may include:
  • Light therapy (phototherapy). Your baby may be placed under a special ultraviolet light or wrapped in a fiber-optic blanket of light. The light changes the bilirubin into a form that can be eliminated by your baby's kidneys. Newborns with jaundice typically receive phototherapy for several days.

  • Intravenous immunoglobulin (IVIg). If moderate to severe jaundice develops because of blood group differences between mother and baby, an intravenous transfusion of antibodies may decrease the jaundice and lessen the need for exchange blood transfusion.
  • Exchange blood transfusion. Rarely, when severe jaundice doesn't respond to other treatments, a baby may need an exchange transfusion of blood. This involves repeatedly withdrawing small amounts of blood, "diluting out" the bilirubin and maternal antibodies, and then transferring blood back into the baby — a procedure that's performed in a newborn intensive care unit.


Credit: National Institute of Health.
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