New parents undoubtedly are checking their baby all the time: How is he feeding or sleeping? Why is she crying? There seem to be so many things to worry about with a new baby. One of the most common health concerns for parents is jaundice (the yellow color that appears in a baby’s skin), which occurs in two or three of every four newborns. It usually is noticed first on the face and then spreads to the rest of the body. Jaundice also can be seen in the whites of a baby's eyes. The best way to see jaundice is in good light, such as daylight or fluorescent light. However, it always is more difficult to see jaundice in infants with darker skin color.
Jaundice typically appears in the first few days of life, when a chemical called bilirubin builds up in a baby's blood. The liver normally helps the body get rid of bilirubin, but a newborn's liver is not yet mature enough to take care of all the bilirubin in the baby’s system during the first few days of life. When the amount of bilirubin in the blood is higher than normal, the skin starts to look yellow. The liver is better able to get rid of bilirubin after a few more days of life, so most infants naturally become less jaundiced on their own over time.
Mild jaundice is not cause for alarm. On the other hand, bilirubin levels in some babies can get higher, with more jaundice, a condition known as hyperbilirubinemia. When this occurs, a newborn is at risk of more serious health complications, including brain damage. For this reason, it is critically important that parents, and doctors and nurses, pay close attention to the amount of jaundice during a baby's first few days of life. In an effort to raise awareness about the need for close monitoring of all newborns and the risk factors for severe jaundice, the American Academy of Pediatrics released updated guidelines on the management of hyperbilirubinemia in full-term newborns. These guidelines stress that close follow-up is particularly important, since most newborns leave the hospital within 24 to 48 hours after birth, before bilirubin levels reach their highest level and before breast-feeding is well established.
Jaundice is more likely to occur in babies who are breast-fed, and especially in those babies who are not feeding well. To keep bilirubin levels down and to help babies stay well hydrated and gain enough weight, mothers should nurse their babies at least eight to 12 times a day for the first few days. Breast milk is the ideal food for babies, but poor feeding can make bilirubin levels go up. Talk with a doctor, nurse or lactation specialist for help with breast-feeding.
Since bilirubin levels continue to rise for a few days after birth, it is important that most newborns have a visit with a nurse or doctor when the baby is 3 to 5 days old. If necessary, the bilirubin level in the blood can be checked at that visit. The babies who are more likely to have hyperbilirubinemia (and sometimes need to be seen even sooner after discharge) are those who:
- Had a high bilirubin level before leaving the hospital
- Were born more than two weeks early
- Looked jaundiced within the first 24 hours of life
- Are not breast-feeding well
- Have a lot of bruising or bleeding under the scalp after labor and delivery
- Have a family member who had hyperbilirubinemia when he or she was a baby and received therapy with lights
Mild jaundice usually is not dangerous and tends not to require treatment. However, when the amount of bilirubin in the blood becomes too high, treatment, such as putting the infant under special lights while he is undressed, can help bring down the bilirubin level. Jaundice must be treated early, so that the rare harmful effects of hyperbilirubinemia can be avoided.
Although every newborn's skin turns at least a little yellow, jaundice should always be taken seriously. Be sure to check with your baby's doctor about jaundice if your baby's skin turns more yellow or the whites of her eyes seem yellow. Also call your baby's doctor right away if your baby looks jaundiced and is having a hard time waking up, is fussy, or is just not feeding well. Jaundice usually only lasts for two to three weeks in breast-fed infants and for two weeks in formula-fed infants. Talk with your baby's doctor if your baby's jaundice lasts for more than three weeks or if it seems to be getting worse at any age.
Henry H. Bernstein, D.O., is a senior lecturer in Pediatrics at Harvard Medical School. In addition, he is chief of General Academic Pediatrics at Children's Hospital at Dartmouth and professor of pediatrics at Dartmouth Medical School. He is the former associate chief of General Pediatrics and director of Primary Care at Children's Hospital Boston.