Jaundice of the newborn
Jaundice is a common occurrence in newborn babies. Jaundice means a yellowish coloration of the skin that can be harmless
in the newborn, or a sign of disease in the infant, older child, or adult.
In the newborn this yellow skin color commonly appears at about 2 to 4 days after birth. At the time of the baby’s delivery the baby’s blood system maintains extra red blood cells, because the birth process places extra demands for nutrients. After the need for added oxygen disappears, the body breaks down some red blood cells. The chemical by-products of blood break-down get filtered through the liver. One chemical called bilirubin is released into the blood and this same chemical causes a yellow color when it gets deposited in the skin. For most babies the appearance of the yellowed skin is barely noticeable and many parents do not even detect it. The face is the first area to pick-up the yellowing, and you will see the yellow color spread toward the feet, if the jaundice is worsening. If you notice the whites of the eyes (sclera), becoming yellow, the jaundice is getting worse. By the time the body, legs, or eyes are yellow, the jaundice requires further medical attention. You should call the my office. Make the judgment about the severity of jaundice after you place your child in natural light. Artificial lights used in a lighted room with curtains closed or at night will give the false impression of jaundice. Most artificial lighting will give the skin a yellow coloring.
There might be a need to treat jaundice depending on its cause. I just described the normal or physiologic jaundice of the newborn. But there can be many causes for your baby’s skin to yellow. A common cause is a blood incompatibility called “ABO” incompatibility. This is when the baby’s major blood groups differ from the mother’s. The most common group incompatibility is when the baby’s blood type is “A”, “B”, or “AB” and the mother’s blood type is “O”. The mother can create antibodies to the baby’s blood group. Damage to the baby’s blood results in high levels of bilirubin in the blood. Bilirubin is harmless in low levels, but if the levels are very high, injury to the nervous system and brain occur. In most cases this problem is picked up shortly after birth with normal screening of babies who are born from group “O” mothers. When the level of bilirubin reaches a certain level, treatment might be started. The traditional treatment is with phototherapy. This is a special light treatment which lowers the bilirubin in the baby’s body. Babies are placed naked under the light with eye patches protecting the eyes from the intense light. This treatment can last from one day to many days depending on the severity of the jaundice and health of the baby.
Another blood incompatibility problem that results in a more serious problem is Rh incompatibility. This is a blood factor we call (+) positive or (-) negative, such as A + or AB -. This type of blood reaction can be serious and require blood exchanges and phototherapy.
Other reasons for jaundice in the newborn period are many. One common problem in breast feeding mothers is persisting jaundice or jaundice without blood group incompatibilities. There appears to be an association with breast feeding and exaggerated jaundice. There are certain chemicals produced in breast milk which seem to enhance normal jaundice. It is not always clear whether it is the breast milk or some mild dehydration from inadequate breast milk causing the exaggerated jaundice. The first treatment is to add extra water after feeding. If the jaundice is substantial, the bilirubin is high, and there are no other signs of problems, I might start the baby on formula for one to two days. After the bilirubin is lower and in the safe range, I will restart the breast feeding again. Mothers should discard the pumped breast milk.
Jaundice can also be a sign of infection, hormone imbalance, and appear in premature infants with an immature liver. Last reviewed 5/7/2010
Many parents will bring in their older infant, usually 6 to 18 months of age. These parents are concerned about their child’s yellow skin. When examined closely, these kids have especially yellow soles of their feet, palms of their hands, and general yellowness of the rest of their skin. What is missing is yellowness of the whites of the eyes (sclera). Further questions turns up a strong emphasis in the diet of yellow vegetables. This increased pigmentation is harmless and disappears if there is a change in the diet with a decrease in carrots and squash.
The above link describes the policy associated with Dr. Simonian's Google Assistant app (bilirubin Guide) he developed to help him determine what values of total bilirubin would be safe to observe in a well or low risk baby, verses the higher risk newborn who is premature or has an infection or other condition that might need further follow up or hospital care.