Newborn Jaundice

     Jaundice –yellow discoloration- is the result of having too much yellow-colored pigment called bilirubin in the blood stream. First, the face and the whites of the eyes become yellow. Then the yellow coloration of the skin progresses down the body until finally the feet are yellow.  High bilirubin can leak into the brain and cause a severe form of permanent brain damage called kernicterus.  Rates of kernicterus have been increasing in this country with the increase of breastfeeding and the increase in early discharge of infants from the nursery. Breast milk often takes two or three days to get well established and, in that time, an infant can become dehydrated which makes the bilirubin levels higher.  Jaundice slowly develops over the second or third day of life and it is difficult for the parents at home to evaluate how much discoloration is present in their infant’s skin.

      There are different ways of measuring the amount of bilirubin in an infant’s blood stream. The classic way is to measure the blood directly.  Another way is to place an electronic monitor on the skin and measure the bilirubin level through the skin without drawing blood. The skin measurement is accurate as long as the monitor is working properly. Many doctor’s offices now have these machines but it is important that the machine routinely is compared to blood samples to ensure the accuracy of the machine..

     High bilirubin levels are treated with exposure to a specific kind of light that changes the bilirubin into a harmless chemical. The treatment can be done at home or in the hospital but the levels of bilirubin should be checked frequently to ensure that the treatment is working.

     Without treatment, bilirubin levels increase slowly over about a week and then drop. Breast –fed infants have jaundice for longer than bottle-fed infants.  If even a small amount of jaundice is noticed in the nursery, the infant’s bilirubin level should be measured at the time the jaundice is noticed. If it is elevated, the test should be repeated after the infant is discharged until the level starts to go down. If an infant is premature, if the infant’s blood type is different from the mother’s, or if the breast-feeding isn’t going well, the risk of jaundice is higher and the level of bilirubin should be monitored more closely. At no time should a parent be sent home and just told to “watch the infant” and return if they think the jaundice is worse. The bilirubin level needs to be checked until it starts to go down and it is certain that the infant is safe.