Jaundice in Newborns (page 3)

Facts about Jaundice and Kernicterus

Jaundice is the yellow color seen in the skin of many newborns. Jaundice happens when a chemical called bilirubin builds up in the baby’s blood. During pregnancy, the mother’s liver removes bilirubin for the baby, but after birth the baby’s liver must remove the bilirubin. In some babies, the liver might not be developed enough to efficiently get rid of bilirubin. When too much bilirubin builds up in a new baby’s body, the skin and whites of the eyes might look yellow. This yellow coloring is called jaundice.

When severe jaundice goes untreated for too long, it can cause a condition called kernicterus. Kernicterus is a type of brain damage that can result from high levels of bilirubin in a baby’s blood. It can cause athetoid cerebral palsy and hearing loss. Kernicterus also causes problems with vision and teeth and sometimes can cause intellectual disabilities. Early detection and management of jaundice can prevent kernicterus.

Signs and Symptoms

Jaundice usually appears first on the face and then moves to the chest, belly, arms, and legs as bilirubin levels get higher. The whites of the eyes can also look yellow. Jaundice can be harder to see in babies with darker skin color. The baby’s doctor or nurse can test how much bilirubin is in the baby’s blood.

See your baby’s doctor the same day if your baby:

• Is very yellow or orange (skin color changes start from the head and spread to the toes).
• Is hard to wake up or will not sleep at all.
• Is not breastfeeding or sucking from a bottle well.
• Is very fussy. Does not have enough wet or dirty diapers.

Get emergency medical help if your baby:

• Is crying inconsolably or with a high pitch.
• Is arched like a bow (the head or neck and heels are bent backward and the body forward).
• Has a stiff, limp, or floppy body.
• Has strange eye movements.

Diagnosis

Before leaving the hospital with your newborn, you can ask the doctor or nurse about a jaundice bilirubin test.

A doctor or nurse may check the baby’s bilirubin using a light meter that is placed on the baby’s head. This results in a transcutaneous bilirubin (TcB) level. If it is high, a blood test will likely be ordered.

The best way to accurately measure bilirubin is with a small blood sample from the baby’s heel. This results in a total serum bilirubin (TSB) level. If the level is high, based upon the baby’s age in hours and other risk factors, treatment will likely follow. Repeat blood samples will also likely be taken to ensure that the TSB decreases with the prescribed treatment.

Bilirubin levels are usually the highest when the baby is 3 to 5 days old. At a minimum, babies should be checked for jaundice every 8 to 12 hours in the first 48 hours of life and again before 5 days of age.