Jaundiced Newborn

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
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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
  • Jaundice has reached the legs
  • 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 of life AND 4 or more days old AND hasn't been examined since discharge (Reason: AAP recommends re-check)
  • High-risk baby for severe jaundice (premature baby of 35 weeks or earlier, ABO or Rh blood group problem, sibling needed bili-lights)
  • 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.
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HOME CARE ADVICE

  1. Bottlefed: If bottle fed, increase the frequency of feedings. Try for an interval of every 2 to 3 hours during the day.
  2. 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.
  3. 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.
  4. Expected Course: Physiological jaundice peaks on day 4 or 5 and then gradually disappears over 1-2 weeks.
  5. 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.
  6. 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.

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REFERENCES

  1. American Academy of Pediatrics, Provisional Committee for Quality Improvement. Practice parameter: management of hyperbilirubinemia in the healthy term newborn. Pediatrics. 1994;94:558-565.
  2. 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.
  3. American Academy of Pediatrics, Subcommittee on Neonatal Hyperbilirubinemia Neonatal jaundice and kernicterus. Pediatrics. 2001;108:763-764.
  4. Bhutani V, Johnson L and Keren R. Treating acute bilirubin encephalopathy-before it’s too late. Contemp Pediatr. 2005;22(5):57-74.
  5. 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.
  6. Dixit R and Gartner LM. The jaundiced newborn: Minimizing the risks. Contemp Pediatr. 1999;16(4):166-183.
  7. Gartner LM, Herrarias CT, Sebring RH. Practice patterns in neonatal hyperbilirubinemia. Pediatrics. 1998;101:25-31.
  8. Gartner LM. Neonatal jaundice. Pediatr Rev. 1994;15:422-432.
  9. Maisels MJ. Neonatal jaundice. Pediatr Rev. 2006;27(12):443-454.
  10. Maisels MJ. Jaundice in a newborn. Contemp Pediatr. 2005;22(5):34-54.
  11. Moyer VA, Ahn C, Sneed S. Accuracy of clinical judgment in neonatal jaundice. Arch Pediatr Adolesc Med. 2000;154:391-394.
  12. 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.

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