JAUNDICED NEWBORN
Definition
- The skin and whites of the eyes are yellow.
Types of Jaundice
Physiological jaundice (50% of newborns)
- Onset 2 to 3 days of age
- Peaks day 4 to 5, then improves
- Disappears 1 to 2 weeks of age
Breastfeeding jaundice(5 to 10% of newborns)
- Due to inadequate intake of breastmilk
- Pattern similar to physiological type
Breastmilk jaundice (1% of newborns)
- Due to substance in breastmilk which blocks destruction of bilirubin
- Onset 4 to 7 days of age
- Lasts 3 to 10 weeks
- Not harmful
Rh and ABO blood group incompatibility
- Onset during first 24 hours of life
- Can reach harmful levels
WHEN TO CALL YOUR DOCTOR
Call 911 now (your child may need an ambulance) if:
- Unresponsive or difficult to awaken
- Not moving or very weak
Call your doctor now (night or day) if:
- Newborn starts to look or act sick (e.g., decrease in activity, ability to suck).
- Signs of dehydration (No urine in 8 hours, very dry mouth, sunken soft spot).
- Fever above 100.4°F (38.0°C) rectally. (Caution: Do NOT give your baby any fever medicine before being seen)
- Low temperature below 96.8° F (36.0°C) rectally that doesn't respond to warming.
- Jaundice began during the first 24 hours of life.
- Skin looks deep yellow or orange
- You think your child needs to be seen
Call your doctor within 24 hours (between 9am and 4pm) if:
- You are concerned your baby is not getting enough breastmilk.
- Good-sized yellow, seedy stools are less than 3 per day.
(EXCEPTION: breastfed and before 5 days of life - Day 2-4 of life and no stool in over 24 hours and breastfed
- Wet diapers are less than 6 per day.
(EXCEPTION: 3 wet diapers/day can be normal before 5 days of life if breastfed) - Discharged before 48 hours AND 4 or more days old AND hasn't been examined since discharge (Reason: AAP recommends re-check)
- Blood type problem (ABO, Rh) present
- You have other questions or concerns
Call your doctor during weekday office hours if:
- Color gets deeper after 7 days old.
- Jaundice is not gone after 14 days old.
- Jaundice began or reappeared after 7 days of age.
- Stools are white, pale yellow or gray.
Parent care at home if:
- Mild jaundice of newborn and you don't think your child needs to be seen.
HOME CARE ADVICE
- Bottlefed: If bottle fed, increase the frequency of feedings. Try for an interval of every 2 to 3 hours during the day.
- Breastfed: If breastfed, increase the frequency of feedings. Nurse your baby every 1 1/2 to 2 1/2 hours during the day. Don't let your baby sleep more than 4 hours at night without a feeding.
- Increase Stools:
- If your baby is 5 days or older AND has less than 3 stools/day, carefully insert a lubricated thermometer 1/2 inch (12 mm) into the anus and gently move it from side to side a few times to stimulate a stool.
- Reason: increased stools carry more bilirubin out of the body
- Do this once or twice per day until jaundice improves or stool frequency becomes normal.
- Expected Course: Physiological jaundice peaks on day 4 or 5 and then gradually disappears over 1-2 weeks.
- Judging Jaundice:
- View your baby unclothed in natural light near a window.
- Press on the yellow skin on the chest with a finger to remove the normal skin tone.
- Then assess the jaundice color before the pink color returns.
- Call Your Doctor If:
- Jaundice not gone by day 14
- Your baby is not getting enough milk (needs a weight check)
- Your baby starts to act sick
- Your child becomes worse
And remember, contact your doctor if your child becomes worse or develops any of the "Call Your Doctor" symptoms.
REFERENCES
- American Academy of Pediatrics, Provisional Committee for Quality Improvement. Practice parameter: management of hyperbilirubinemia in the healthy term newborn. Pediatrics. 1994;94:558-565.
- American Academy of Pediatrics, Subcommittee on Hyperbilirubinemia. Clinical Practice Guideline: Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation. Pediatrics. 2004;114(1):297-316.
- American Academy of Pediatrics, Subcommittee on Neonatal Hyperbilirubinemia Neonatal jaundice and kernicterus. Pediatrics. 2001;108:763-764.
- Bhutani V, Johnson L and Keren R. Treating acute bilirubin encephalopathy-before it’s too late. Contemp Pediatr. 2005;22(5):57-74.
- Chiu A. Unconjugated hyperbilirubinemia. In: Moyer V, Davis RL, Elliott E, et al, eds. Evidence Based Pediatrics and Child Health. London, England: BMJ Publishing Group; 2000. p. 306-312.
- Dixit R and Gartner LM. The jaundiced newborn: Minimizing the risks. Contemp Pediatr. 1999;16(4):166-183.
- Gartner LM, Herrarias CT, Sebring RH. Practice patterns in neonatal hyperbilirubinemia. Pediatrics. 1998;101:25-31.
- Gartner LM. Neonatal jaundice. Pediatr Rev. 1994;15:422-432.
- Maisels MJ. Neonatal jaundice. Pediatr Rev. 2006;27(12):443-454.
- Maisels MJ. Jaundice in a newborn. Contemp Pediatr. 2005;22(5):34-54.
- Moyer VA, Ahn C, Sneed S. Accuracy of clinical judgment in neonatal jaundice. Arch Pediatr Adolesc Med. 2000;154:391-394.
- Palmer HR, Clanton M, Ezhuthachan S, et al. Applying the 10 simple rules of the institute of medicine to management of hyperbilirubinemia in newborns. Pediatrics.. 2003;112(6):1388-1393.
Disclaimer: This information is not intended be a substitute for professional medical advice. It is provided for educational purposes only. You assume full responsibility for how you choose to use this information.