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One of the most common medical problems in new babies is jaundice, seen as a yellow color in the skin and the whites of the eyes. This yellow pigment is an accumulation of the breakdown products of red blood cells which are normally processed in the liver. Infants at birth are often given a burst of red cells from the mother’s placenta, and these blood cells decompose faster than the red cells of older children and adults. In addition, the liver of newborns is still immature and is not able to chemically process the old red cell “bilirubin” as quickly as an older child, allowing this waste product to build up levels in the blood, and deposit in the skin. Doctors call the tendency for newborns to get a little yellow around day 3 to 4 of life, “physiologic jaundice” and advise mothers to feed their infants every 2 to 4 hours and keep them near sunny windows to help this mild jaundice disappear naturally. The bilirubin is cleared out of the body in the yellow stools of newborn babies.
Some newborns have jaundice that is more extreme, where levels of bilirubin in the blood rise too high too quickly. This can happen if the mother and baby have blood types that are incompatible. That is why every mother’s blood type is checked with her prenatal blood tests. If the mom is an “O” or is “Rh negative” her baby’s cord blood will be typed to see if there is an incompatibility. Mothers who are “Rh negative” and have an “Rh positive” baby are given a shot of Rhogam after the birth. Higher than expected levels of bilirubin can also result from poor feeding, infection, and birth defects in the blood or the liver. Doctors carefully monitor the bilirubin level in newborns using a specialized skin sensor as well as blood tests.
If the doctor sees that the bilirubin level is higher than normal for the baby’s age, he can place the infant under a “bili-light” or a “bili-blanket” or on a “bili-bed” and monitor the level of bilirubin in the blood with repeated blood tests. This can be done in the hospital or by a visiting nurse in the home. Keeping the infant’s eyes protected from the UV light, this method helps the liver to process the bilirubin to a less toxic form and speeds the passage of bilirubin out of the body. Babies complete the light therapy in a few days and are perfectly healthy after it is done. Premature infants are most likely to need treatment since their livers are even more immature than a full term newborn’s liver. Untreated excessively high levels of bilirubin cause “kernicterus” which can result in neurologic damage to the developing brain. In rare cases, the bilirubin rises so high that the infant requires an exchange transfusion in the NICU by the neonatologist. However, with the ease of skin sensors to monitor newborns and rapid blood testing, this is hardly ever necessary today.
While “physiologic jaundice” is usually seen in the first
week of life, “breastmilk jaundice” tends to occur around 2 to 4
weeks of age. Although the exact cause is still unclear, this problem is
easily solved by feeding the infant only formula for 1 or 2 days, and
then resuming breastfeeding as usual. The appearance of jaundice
beyond this age requires additional evaluation.
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