Jaundice refers to the yellow coloring of the skin that commonly occurs in newborns. Our blood is made up of red blood cells that get broken down as part of normal body processes. A substance called “bilirubin” is produced when these red blood cells are broken down. Bilirubin is processed in the liver and exits our body in urine and stool. However, newborns have immature livers that are not yet efficient in processing bilirubin. Additionally, newborns have more red blood cells with a shorter lifespan compared to older children and adults. This leads to an increased bilirubin load on the liver, resulting in newborn jaundice.
For the reasons explained above, many babies have jaundice appearing on the 1st or 2nd day of life. Jaundice starts around the head and the face (including the whites of the eyes) and moves down to the rest of the body. Babies might look more yellow for a few more days before their color slowly gets better. All babies typically have their jaundice level checked before being discharged from the hospital at around 24 hours after birth. Jaundice is not inherently harmful until it reaches a certain threshold.
In some babies with certain risk factors, jaundice might worsen and reach harmful levels. This is often captured at the hospital during routine checks. Some of these risk factors that can cause high jaundice levels include:
If jaundice reaches harmful levels in babies, their brains might be affected irreversibly, which is the main reason for treatment. Treatment includes a type of light therapy called “phototherapy.” Phototherapy works by breaking down bilirubin, found on babies’ skin, into compounds that are easily removed in stools and urine. Phototherapy works well for most babies and has minor side effects of temporary skin rashes and loose stools.
For babies with jaundice levels that are not high enough to warrant treatment with phototherapy, frequent feeding is the single most helpful intervention parents can do at home. This helps in the excretion of bilirubin in urine and stools quickly. Sometimes, short-term formula supplementation might be advised by pediatricians if breastmilk is not adequate and if the baby is not gaining weight in addition to having jaundice.
In otherwise healthy babies (without the risk factors noted above) who are feeding well, gaining good weight, voiding, and stooling appropriately, we worry less about jaundice getting worse. Additionally, as babies begin to mature and the red blood cell amounts decrease in their circulation, there will be less load on their liver to process bilirubin.
In babies who have risk factors and needed phototherapy in the hospital, we may monitor their jaundice level in the office with a device that tests their skin. If the skin test level is high, we might order blood tests. We may need to continue monitoring levels in the office for a few visits to make sure they remain under harmful limits. Very rarely, some babies do need to return to the hospital for repeat phototherapy if jaundice levels remain high.
Jaundice will typically subside in both scenarios within 1-2 weeks after birth.