Newborn Jaundice

Posted 05-4-2010 at 10:36 AM by MinnieBees

Almost all newborns develop jaundice, but many parents don’t know much about this common condition. How is jaundice diagnosed? Why do babies get jaundice? Why do some babies need to be treated while some don’t? Can you breastfeed if your baby has jaundice? Is breastfeeding jaundice dangerous? Hopefully I can answer some of these questions.

Jaundice is the accumulation of the pigment bilirubin in the blood. Before babies are born they have a high red blood cell count, because the oxygen environment is less rich before birth. After birth the baby will breakdown the red blood cells it doesn’t need, and that process will release bilirubin. In addition to this process, the newborn’s liver is not mature enough to adequately clean the bilirubin out of the blood. By the end of the first week of life the liver is functioning almost normally. This liver function is why premature babies are at a higher risk of having the bilirubin spill into the brain, which can be devastating. There is an enzyme in the liver that cleans the bilirubin from the blood, and at 36 weeks gestation it is working at 1/100th of the level that a normal liver is working at.

Most parents will notice that their baby looks a little yellow in their skin tone at about 2 days of life, and that color will peak at about 5-6 days of life. A baby with a low level of jaundice will be a little yellow in their face, but a baby with high bilirubin will be yellow down to their thighs, or below. Jaundice is typically diagnosed by a heel stick, or TCB (transcutaneous bilirubin, a noninvasive device that can measure bilirubin through the skin of the forehead). The number is then compared to the baby’s age on a chart to determine the risk level. This risk level is to prevent a condition called bilirubin encephalopathy. When the levels of bilirubin get too high in the blood, it can cross the blood brain barrier, having devastating effects on the brain. No one is sure what that level is, so the goal is to prevent the level from getting too high. If your baby plots out at low risk on the chart, then your baby is at a low risk of developing bilirubin encephalopathy. If your baby is at a high risk, then your doctor will probably recommend treatment. Thankfully, most jaundice is easily treated with UV lights. In rare cases phototherapy is insufficient, and then jaundice can be treated with an exchange transfusion, but that is extremely rare.

Bilirubin is mostly secreted out of the stool, sometimes turning it green in color. Because it is secreted through the stool, feeding your baby will help the jaundice reduce. And that is where breastfeeding jaundice comes in. If your baby has severe jaundice then you may think that you can’t breastfeed, but that is untrue. Breastfed babies will be jaundiced longer, but a low level of bilirubin in the blood is harmless to your baby. It is only the very high levels that can be dangerous, and those can be treated with UV lights. It is not abnormal for a breastfed baby to have jaundice for weeks, or even months, but it is not harmful. So, if your baby has jaundice, you can breastfeed! If jaundice is very severe, then supplementation may be helpful (although probably not needed), but jaundice won’t prevent you from being able to breastfeed.

Some babies are at a higher risk of bilirubin encephalopathy than others. Premature infants are at a higher risk because of the liver function that I mentioned earlier. Babies born to women who are Rh sensitized are another high risk group. This is why rhogam is recommended for women who are a negative blood type, but are married to a positive blood type father. However, there are many more Rh factors than + and -, but that is beyond this article (I happen to be sensitized to anti-E). Another risk factor is ABO incompatibility. If the mother’s blood type is O and the father’s is A, B or AB, then the baby is at a higher risk of jaundice. Asian babies also have a higher risk of jaundice that needs to be treated, but no one is sure why.

I hope that this has given you some information about a very common newborn condition. All three of my kids have had varying levels of jaundice. My first was born premature and had levels spike up to nearly 22 on her 4th day of life. My second had very similar numbers because I developed an Rh sensitivity, and my third had low levels of jaundice that did not need to be treated. So this is a topic that is close to my heart, and I hope it has been informative.

My premature baby girl being treated for jaundice

Is that a baby, or is that a pumpkin?

Filed Under: Family Health, General


10 Responses to “Newborn Jaundice”

  1. momtoesther on May 4th, 2010 6:26 pm

    Both my dd’s had to go back to the hospital to get treated. Jaundice also makes breastfeeding difficult as the baby is often too tired to suck. No eating = no poop = no improvement = more tired = no eating.

  2. DaisyDiaper728 on May 4th, 2010 8:43 pm

    My DD was Coombs+ because of our Rh imcompatibility and was under the bili lights for 3 days when her bilirubin level spiked at less than 24 hours old. I was in a very pro-breastfeeding hospital but the ped on call wasn’t apparently and ordered her to be given formula without even asking us! My milk came in quickly and abundant, though, so I began pumping right away and the nurses just quietly stopped the formula and gave her the breastmilk. We ended up with a few difficulties BFing b/c she was separated from me so much and on top of that I became engorged. But we overcame and she got Mama milk for 9.5 months, though much of it was from pumping.

  3. candijunkie on May 5th, 2010 10:06 am

    i had rhogam both before and after i had dd and didnt know it tied into jaundice. we had to take her back to the hospotal after 2 weeks because she was too yellow and her count was high she was under the lights overnight and was low enough to leave the following afternoon though on a happier note the “sunglasses” were soo cute :)

  4. LnZsmomma on May 5th, 2010 4:46 pm

    my oldest son, landan, who is 4 now, had jaundice when he was an infant. we had him on the biliblanket for what seemed like forever. our pediatrician sent us to a pediatric endocrinologist over three hours away. tests were run and he has a condition known as alpha 1 antitryspin deficency. alpha 1 is a protein that occurs in the body and my sons levels are extremely low. he is a phenotype zz and that is what caused his jaundice. it causes jaundice in newborns and lung disease and emphysema in adults (even those who have never smoked). it is a super serious disease and is farely new and unheard of. most doctors are not very informed or educated on it. there is no cure for this disease. there is only preventative measures that need to be taken. i wish more people knew about it.

    when my second son, zander, was born i went through the same situation. he had jaundice and was also on the biliblanket forever. and he was tested by the mayo clinic for the same disease his brother has. when the results came back it turned out they only tested the levels of these proteins and not the phenotype and his levels were also low but not as low as his brothers. so we will need to get him tested again when we go to see the specialist (every summer for landan) and see what phenotype zander is.

    i was tested and am an mz (one normal m gene and an abnormal z gene = carrier). zanders father was tested and is an mnull (one normal m gene and no second gene = more of a chance for lung problems). landan has a different father. his father was tested but i don’t know his results…either has to be an mz, sz, or zz i would assume if landan got one z gene from me he would of had to get the second z gene from his father.

    i wish every body would be tested for this so we can learn more about it. they have free testing at the medical university of south carolina.

  5. Jill on May 7th, 2010 5:09 am

    Momtoesther is right! If your baby can’t wake up to suck to eat then the baby can’t get better. We had a severely jaundiced baby. I pumped milk for 3 months because as soon as she had started to learn to nurse on her own, they forced us to put her under the warming lights and not take her out. Eventually we got the hang of nursing but it was a giant pain before that. If anyone else ever has a baby with jaundice ASK FOR THE BLANKET! We did not hold our newborn baby for the first 6 days she was in the hospital because they told us the only way she could get better was by staying under the warmer. If we did that, then maybe she could go home without equipment. They neglected to tell us that we could get a blanket with the same lights in it—until we were signing out to leave. I still want to pummel them for that.

  6. samanthapalacio on May 9th, 2010 5:00 pm

    My baby boy was born at 36 weeks and his levels spiked to 23 on day 4. The pediatrician mistakenly sent him home and at 9:00 that evening they call telling us to rush him to the hospital immediately. It was very scary! He was sooo orange. I think the stay in the “tanning bed” and sleeping on his side in it has affected his sleeping habits now because I still loves to sleep on his side!

  7. samanthapalacio on May 9th, 2010 5:05 pm

    I uploaded a Gravatar to show my little one

  8. zeotwoski on May 14th, 2010 6:31 pm

    My 37 weeker was up to 23.1 on day 4, my 36 weeker was only up to 17 but never got below 14, just got old enough that that was no longer a high level. They both spent 2 days under the lights, but we were able to take them out for feedings–they both breastfed just not very well, which was part of the problem with the 37 weeker. He ended up on a nasal gravage but after one dose of pedialyte he was given breastmilk through the tube. He was then on a finger feeder for the first two weeks until he learned to latch on, then BFed for over a year. We’ll find out very soon if baby #3 develops jaundice…

    Oh also my 36 weeker had a lot of facial bruising from being born so fast, and that also contributes to jaundice because the body has to then break down those additional blood cells in the bruise.

  9. mamma2masonmyah on May 17th, 2010 2:01 pm

    Just a side note…some bili levels are too high to be treated with the blanket alone. That is for less severe jaundice. The overhead lights and bili beds are more effective to quickly bring down levels and then those babies are transferred to the blanket as soon as possible. That doesn’t mean the baby cant come out for feedings by mom. :) In any circumstance babies always do better with lots of mommy time.

  10. Melinda29 on May 19th, 2010 7:00 pm

    One way to reduce the likelihood of your infant developing jaundice is to insist that your doctor/midwife wait until the umbilical cord stops pulsating before clamping and cutting (30 seconds to five minutes after the birth). This allows the stem-cell rich cord blood to reenter the child’s blood stream, also reducing incidence of anemia, the rates of oxygen assistance, and increasing breastfeeding success. Of course it won’t prevent jaundice in all cases, especially pre-term infants, but it is an easy and effective way to significantly reduce the risk.

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