What are the Signs of Jaundice in a Baby? A Comprehensive Guide

Newborn jaundice is a common condition affecting many infants in the first few weeks of life. It’s characterized by a yellowish discoloration of the baby’s skin and the whites of their eyes, and while it can be alarming for new parents, it’s often a normal physiological process.

This post will delve into the causes, symptoms, diagnosis, treatment, and prevention of newborn jaundice, providing you with the information you need to navigate this common condition with confidence.

What is Jaundice?

Jaundice occurs due to a buildup of bilirubin in the blood, a condition known as hyperbilirubinemia. Bilirubin is a yellow pigment produced when red blood cells break down. Normally, the liver processes bilirubin, making it water-soluble so it can be excreted from the body through urine and stool.

In newborns, the liver is often not yet fully mature and may not be able to process bilirubin efficiently, leading to its accumulation in the blood. It is normal for a baby’s bilirubin level to be a bit high after birth. When the baby is growing in the mother’s womb (uterus), the placenta removes bilirubin.

Causes of Newborn Jaundice

Several factors can contribute to the development of jaundice in newborns. Understanding these causes can help in early detection and management.

Physiological Jaundice

The most common type of newborn jaundice is physiological jaundice.

This occurs in most newborns as their livers mature and become more efficient at processing bilirubin. It usually becomes noticeable when the baby is 2 to 4 days old. Physiologic hyperbilirubinemia occurs in almost all neonates.

Bilirubin levels typically rise over the first 3 to 4 days of life (7 days in East Asian infants).

Breastfeeding Jaundice

Breastfeeding jaundice can occur in two forms: early-onset and late-onset.

• Early-onset breastfeeding jaundice: This happens in the first week of life when the baby isn’t getting enough breast milk. This can be due to difficulties with breastfeeding technique or insufficient milk supply. The reduced intake leads to less frequent bowel movements, which means less bilirubin is excreted.
• Late-onset breastfeeding jaundice: This occurs after the first week and can last for several weeks. It’s thought to be related to substances in breast milk that interfere with the liver’s ability to process bilirubin.

Blood Group Incompatibility (Rh or ABO)

If the mother and baby have different blood types (Rh incompatibility or ABO incompatibility), the mother’s immune system may produce antibodies that attack the baby’s red blood cells. This leads to a rapid breakdown of red blood cells and a surge in bilirubin levels.

Other Medical Conditions

Certain medical conditions can also cause jaundice, including:

• Cephalohematoma: A collection of blood under the scalp, which can occur during delivery. As the blood is reabsorbed, it releases bilirubin.
• Infections: Infections, whether bacterial or viral, can impair the liver’s function.
• Enzyme deficiencies: Certain enzyme deficiencies, such as glucose-6-phosphate dehydrogenase (G6PD) deficiency, can lead to increased red blood cell breakdown.
• Biliary atresia: A rare condition where the bile ducts are blocked or absent, preventing bilirubin from being excreted.

Symptoms of Newborn Jaundice

The most obvious symptom of newborn jaundice is the yellowing of the skin and the whites of the eyes (sclera). However, the yellowing may start in the face before spreading across the body. 

As it progresses, the palms of the hands and soles of the feet, as well as the whites of the eyes, may look yellow or show deeper shades of yellow coloring.

The characteristic features of neonatal jaundice include yellowish skin, sclerae, and mucous membranes.

Here’s a more detailed breakdown of the symptoms:

• Yellowing of the skin: This usually starts on the face and then progresses down to the chest, abdomen, and legs.

• Yellowing of the whites of the eyes (sclera): This is often easier to see than the skin discoloration, especially in babies with darker skin tones.

• Poor feeding: Jaundiced babies may be more sleepy and less interested in feeding.

• Lethargy: They may be less active and more difficult to wake up.

• Dark urine: While newborn urine is normally clear, it may become dark yellow or brown.

• Pale stools: Normal newborn stools are yellowish or greenish. Pale, chalky stools can indicate a problem with bilirubin excretion.

Diagnosing Newborn Jaundice

Doctors typically check for jaundice in newborns before they leave the hospital. The AAP recommends an infant’s bilirubin levels should be assessed between 24 and 48 hours after birth. If an infant leaves the hospital prior to this time.

Diagnosis usually involves:

• Visual examination: The doctor will visually assess the baby for yellowing of the skin and eyes.
• Bilirubin level measurement: This can be done through a blood test or with a transcutaneous bilirubinometer, a device that measures bilirubin levels through the skin.
• Further testing: If the bilirubin level is high or if there are concerns about the cause of the jaundice, further blood tests may be needed to check for blood group incompatibility, infection, or other underlying conditions.

Treatment Options for Newborn Jaundice

The treatment for newborn jaundice depends on the severity of the hyperbilirubinemia and the baby’s age.

Phototherapy

Phototherapy (light therapy) is a common treatment for jaundice.In almost all babies, treatment with phototherapy is successful in decreasing bilirubin levels within 24 to 48 hours.

The baby is placed under special blue lights, wearing only a diaper and eye protection. The light helps to convert bilirubin into a form that can be excreted in the urine.

Exchange Transfusion

In rare cases of severe jaundice, an exchange transfusion may be necessary. This involves removing the baby’s blood and replacing it with donor blood. This procedure is done to quickly lower bilirubin levels and prevent brain damage.

Intravenous Immunoglobulin (IVIg)

Giving intravenous immunoglobulin to babies who have severe jaundice may also be effective in reducing bilirubin levels. Intravenous immunoglobulin (also called IVIg). This is used in cases of Rh or ABO incompatibility to prevent the mother’s antibodies from attacking the baby’s red blood cells.

Addressing Underlying Causes

If the jaundice is caused by an underlying medical condition, such as an infection or enzyme deficiency, treatment will focus on addressing that specific condition.

Home Management

In some cases of mild jaundice, treatment can be done at home. This may involve:

• Frequent feeding: Ensuring the baby gets enough breast milk or formula helps to promote bowel movements and bilirubin excretion.
• Sunlight exposure: Exposing the baby to indirect sunlight for short periods can help to break down bilirubin. However, it’s important to avoid direct sunlight, which can cause sunburn. Always consult with your pediatrician before attempting sunlight therapy.

Preventing Newborn Jaundice

While not all cases of newborn jaundice can be prevented, there are steps you can take to reduce the risk:

• Ensure adequate feeding: Frequent breastfeeding or formula feeding helps to prevent dehydration and promote bilirubin excretion.
• Early detection: Regular check-ups with your pediatrician can help to identify jaundice early, allowing for prompt treatment.
• Manage Rh or ABO incompatibility: If you know you have Rh or ABO incompatibility with your baby, your doctor can take steps to prevent or manage jaundice.

When to Seek Medical Advice

It’s important to seek medical advice if you notice any signs of jaundice in your newborn, especially if:

• The yellowing is severe or spreading rapidly.
• The baby is not feeding well or is very sleepy.
• The baby has a fever.
• The baby is difficult to wake up.
• The baby develops high-pitched cry.

Newborn jaundice usually can be treated to a safe level within 24 hours, though there are some babies who continue to produce more bilirubin and need a few.

Conclusion

Newborn jaundice is a common condition that, while often harmless, requires careful monitoring. Understanding the causes, symptoms, and treatment options can help you navigate this condition with confidence and ensure the best possible outcome for your baby. If you have any concerns about your baby’s health, always consult with your pediatrician.

FAQs About Newborn Jaundice

References

• Newborn jaundice: MedlinePlus Medical Encyclopedia. https://medlineplus.gov/ency/article/001559.htm
• Newborn jaundice | March of Dimes. https://www.marchofdimes.org/find-support/topics/planning-baby/newborn-jaundice
• Patient education: Jaundice in newborn infants (Beyond the Basics). https://www.uptodate.com/contents/jaundice-in-newborn-infants-beyond-the-basics/print
• Neonatal Jaundice – StatPearls – NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK532930/
• Newborn Jaundice: Causes, Symptoms, Treatment, and Prevention. https://www.healthline.com/health/newborn-jaundice
• Jaundice and Breastfeeding – CDC. https://www.cdc.gov/breastfeeding-special-circumstances/hcp/illnesses-conditions/jaundice.html
• What to expect with jaundice in babies | Ohio State Health & Discovery. https://health.osu.edu/health/family-health/getting-rid-of-jaundice-in-babies
• Neonatal Hyperbilirubinemia – Pediatrics – Merck Manuals. https://www.merckmanuals.com/professional/pediatrics/metabolic-electrolyte-and-toxic-disorders-in-neonates/neonatal-hyperbilirubinemia