Newborn jaundice is actually a pretty common condition in infants! But why? Let’s break down jaundice of newborn, jaundice eyes, jaundice definition, newborn bilirubin values, jaundice treatment, jaundice skin, what you can do for your jaundice newborn, and more!
Is Newborn Jaundice Common?
Newborn jaundice is a yellow discoloration of a baby’s skin and eyes that occurs in about 6 out of every 10 babies [1].
60% of full-term newborns develop jaundice in their first week of life and up to 80% of premature infants (born at or before 37 weeks) [2].
How Neonatal Jaundice Occurs
You may still be wondering, “what’s newborn jaundice though?“
Newborn jaundice is caused by a baby’s blood containing excess bilirubin.
Most bilirubin (80%) comes from the natural breakdown of red blood cells, but to get rid of this bilirubin it must get to the liver to become conjugated, which means separating the chemical bonds to make it water-soluble so that it can be urinated out.
However, one of the reasons many babies get jaundice is because they’re born with underdeveloped systems, including their livers which are needed to make unconjugated, fat-soluble bilirubin, conjugated.
Newborn Jaundice from Breast Milk
Infants who are breastfed tend to have higher concentrations of bilirubin.
The American Academy of Pediatric’s most recent update to “Breastfeeding and the Use of Human Milk” states, “This is believed to be physiologic, and there is some evidence that the presence of some bilirubin in neonates is beneficial because bilirubin is a potent antioxidant” [8].
However, poor intake of breast milk from the exclusively breastfed infant in the first days of life, can be associated with pathologic hyperbilirubinemia.
Is Newborn Jaundice Dangerous?
When bilirubin is unconjugated, it is fat-soluble and can cross the blood-brain barrier and deposit into brain tissue.
Too much bilirubin in the brain can cause a serious condition called kernicterus.
Kernicterus is the finding of bilirubin pigment in the brain which can cause brain damage such as cerebral palsy and hearing loss.
When is Newborn Jaundice Dangerous?
The risk of kernicterus begins when newborn bilirubin values reach around 20.
Reaching levels this high is rare, however, this is why practitioners monitor your baby’s levels and use different treatments, as needed, to prevent them from getting too high to be dangerous.
The Different Types of Newborn Jaundice
There are 4 different types of jaundice including:
1. Physiologic Jaundice
Physiologic jaundice is “normal”. Again, physiologic jaundice is beneficial!
For term infants, the average peak bilirubin level is 5-6 mg/dl. Today, yours is likely <1 mg/dl.
2. Non-Physiologic/Pathologic Jaundice
This is an overproduction or decreased clearance of bilirubin that is present within the baby’s first 24 hours of life. Poor intake of breastmilk is associated with pathologic jaundice. Instead, in a study where babies were breastfed various times per day, the babies breastfed 9-11x in the first 24 hours of like had 0% physiologic jaundice [8].
A more recent study found that decreased frequency of breastfeeding, such as ≤7 times a day, is associated with higher bilirubin concentrations, and breastfeeding 9 to 10 times a day is associated with lower bilirubin concentrations [9].
Keep in mind, Jaundice within 24 hours of life is never normal and needs immediate investigation.
3. Breastfeeding Jaundice
This is more like, “lack of breastfeeding jaundice”.
The onset of this type of jaundice occurs within the first few days of life.
Signs of breastfeeding jaundice include:
- Poor feedings
- Delayed stools
- Excessive weight loss (although, consider fluid intake in labor)
- Difficulty breastfeeding
- Sleepy or fussy baby
- Decreased urine and stool output
4. Breastmilk Jaundice
Breastmilk jaundice is prolonged jaundice in an otherwise healthy, breastfed infant who is thriving, eating well, peeing, and stooling normally.
This jaundice is a benign condition that presents in the first or second week of life and can persist as long as 12 weeks before spontaneous resolution [7].
Breastmilk jaundice reportedly affects 1/3 of exclusively breastfed infants, but the cause has not yet been determined.
Newborn Jaundice Signs and Symptoms
Overall, babies with jaundice are pale, lethargic, reluctant to feed, and have yellowing sclera (whites of eyes), and cephalocaudal progression (yellowing color of the body going from head to toes).
In babies with light complexions, look for:
- Yellowing of the skin and eyes
- Yellow urine
- Yellowing of palms of hands and soles of feed
In babies with dark complexions, look for:
- Yellowing of eyes
- Yellowing of gums
- Yellow urine
- Yellowing of palms of hands and soles of feet
Newborn Bilirubin Values and Diagnosis
Your baby’s pediatric provider will check for jaundice signs while in hospital and since bilirubin levels are highest at days 3-5 of life, they may check again at this time if there are symptoms such as jaundice eyes or jaundice skin.
The practitioner may first check by placing a probe on your baby’s head to estimate their bilirubin level. This test shows the transcutaneous bilirubin (TcB) level. If it’s high, the practitioner will order a blood test where they collect blood from your baby’s heel on a card to test the total serum bilirubin (TSB) and confirm the results.
The American Academy of Pediatrics (AAP) uses this newborn jaundice level chart to determine if baby needs treatment. This chart is based on the baby’s total serum bilirubin (TSB) level and age.
Newborn bilirubin values:
- Above 10 mg less than 24 hours old
- >15 mg at 24-48 hours old
- >18 mg at 49-72 hours of
- >20 mg if baby is older than 72 hours old
When Does Newborn Jaundice Peak?
As mentioned above, newborn bilirubin values generally are highest at days 3-5 of life.
When Does Newborn Jaundice Go Away?
Most newborn jaundice goes away by 2-3 weeks of life.
Some will notice a decrease in symptoms starting at 1-2 weeks of treatment with adequate breastfeeding, vitamin D, and phototherapy if needed.
Risk Factors for Jaundice
Risk factors for newborn jaundice can include:
- Babies born before 38 weeks [2]
- Not breastfed enough [3]
- Poor feedings (bad latch), leading to decreased urine and stool
- Sepsis [2]
- Bruising from a difficult birth [2]
- Present liver condition [2]
- Cephalohematoma: a collection of blood typically seen in the parietal area of the skull
Is Newborn Jaundice Hereditary?
UT Southwestern Medical Center explain that we don’t fully understand what causes breast milk jaundice, but, it’s likely genetic, as breast milk jaundice tends to run in families.
“This does not mean the mothers should stop breastfeeding; nothing is wrong with the breast milk. We just need to monitor symptoms for up to 12 weeks after birth.” [10]
How is Newborn Jaundice Treated?
After determining which jaundice your baby has with their pediatric practitioner some, or all, of these treatments may be used for newborn jaundice:
- Feed baby 10-12x every 24 hours
- Fix and work on the breastfeeding problem. Supplement with formula in the meantime if needed.
- Close monitoring
- Phototherapy. Phototherapy includes the use of “bili lights” which are blue-green fluorescent lights that work by converting the unconjugated (fat-soluble) bilirubin to conjugated (water-soluble) bilirubin which can be urinated out. Additionally, if bili lights are needed, your baby will receive this treatment in an incubator and a bili blanket can be used on your baby’s back for breastfeeding.
- 400 IU Baby Vitamin D Drops to help break down bilirubin. Or, research has found that if the breastfeeding mother takes 6,400 IU of vitamin D daily, this provides sufficient vitamin D supplementation for her and her baby.
Read more about vitamin D for you and your baby in: The Complete Guide to Vitamin D in Breastfeeding!
How do You Treat Newborn Jaundice at Home?
- Nurse your baby often. The hydration will help flush out the bilirubin through your baby’s urine. Additionally, this will help your baby’s stool more helping get rid of the bilirubin. This is especially helpful in the early days since colostrum is your first stage of breastmilk for 2-3 days and it is a laxative.
- Vitamin D. As mentioned, vitamin D also helps break down bilirubin. You may consistently expose your baby to sunlight through a window with most of their skin showing for short periods of time since newborns can’t use sunscreen yet. In addition to supplementing with 400 IU of Baby vitamin D Drops or by you taking 6,400 IU of Vitamin D as a breastfeeding mother to satisfy both you and your baby’s recommended requirements [3].
Formula is Often Wrongly Recommended for Jaundice of Newborn
Sometimes formula gets recommended for jaundice, although it should not be.
At the breast, we don’t know how much the baby is getting unless we do a pre- and post-feeding weigh-in. However, with formula, we can know how much baby is getting right then which is helpful in some practitioners’ opinions to help ensure the baby is ridding the bilirubin through their urine and stool as much as possible. Nevertheless, with good feedings at the breast 10-12x a day, this isn’t needed.
Still, supplementation with formula should always be used if there’s a real feeding problem that’s interfering with your baby’s health and taking time to resolve with a lactation consultant.
Does Delayed Cord Clamping Make Jaundice Worse?
ACOG shares about delayed cord clamping referring to only 30-60 seconds after birth before it’s clamped to get all of the benefits [4]. However, this is actually ‘early clamping’.
Delayed cord clamping is becoming demanded by more and more parents as we’re realizing that babies need their blood (wild idea, right?).
At any given time there’s 1/3 of your baby’s blood circulating through the placenta that’s rich in millions of stem cells and iron which is used to make hemoglobin.
One study found when the cord is left unclamped for 60 seconds, babies receive 80% of their blood. And if left unclamped for 3-5 minutes they will receive 87% of their blood.
It’s true that some health professionals don’t delay past 1 minute because they believe it is dangerous and increases the risk of jaundice.
In a 2013 analysis, it was found that there was an increase in light therapy to treat jaundice in babies with delayed cord clamping (4.4% vs early cord clamping: 2.7%). However, this was found by one large dissertation study and the conclusion was still that delayed cord clamping is beneficial [6].
A different review published in JAMA did not include this unpublished study and they did not find any relationship between jaundice and delayed cord clamping [7].
Can Newborn Jaundice Come Back?
It’s rare for bilirubin levels to rise again after stopping jaundice treatment, but it can happen.
If newborn jaundice comes back, this requires follow-up and likely more treatment for you baby.
Can Newborn Jaundice Cause Problems Later in Life?
Newborn jaundice only causes problems later in life if your baby got kernicterus, a type of brain damage caused from high levels of bilirubin in your baby’s blood.
Kernicterus can cause athetoid cerebral palsy, hearing loss, and autism.
Can Newborn Jaundice Cause Autism?
A couple of studies have now confirmed that hyperbilirubinemia is a significant cause of autism spectrum disorder.
But again, only when the bilirubin levels reach values that lead to neurotoxicity. These risks begin when newborn bilirubin values reach around 20 mg.
Questions or Comments?
If you have any questions or comments, please leave them below👇🏻
Talk soon, mama!
– Katelyn Lauren
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Sources:
[1] https://www.nhs.uk/conditions/jaundice-newborn/
[2] https://www.mayoclinic.org/diseases-conditions/infant-jaundice/symptoms-causes/syc-20373865
[3] De Carvalho M, Klaus MH, Merkatz RB. Frequency of breast-feeding and serum bilirubin concentration. Am J Dis Child. 1982 Aug;136(8):737-8. doi: 10.1001/archpedi.1982.03970440081024. PMID: 7102626.
[4] Oberhelman SS, Meekins ME, Fischer PR, et al. Maternal vitamin D supplementation to improve the vitamin D status of breast-fed infants: a randomized controlled trial. Mayo Clin Proc. 2013;88(12):1378-1387. doi:10.1016/j.mayocp.2013.09.012
[5] McDonald SJ, Middleton P, Dowswell T, Morris PS. Effect of timing of umbilical cord clamping of term infants on maternal and neonatal outcomes. Cochrane Database of Systematic Reviews 2013, Issue 7. Art. No.: CD004074. DOI: 10.1002/14651858.CD004074.pub3. Accessed 17 May 2022.
[6] Hutton EK, Hassan ES. Late vs Early Clamping of the Umbilical Cord in Full-term Neonates: Systematic Review and Meta-analysis of Controlled Trials. JAMA. 2007;297(11):1241–1252. doi:10.1001/jama.297.11.1241
[7] Bratton S, Cantu RM, Stern M. Breast Milk Jaundice. [Updated 2021 Nov 16]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK537334/
[8] De Carvalho M, Klaus MH, Merkatz RB. Frequency of breast-feeding and serum bilirubin concentration. Am J Dis Child. 1982 Aug;136(8):737-8. doi: 10.1001/archpedi.1982.03970440081024. PMID: 7102626.
[9] Hassan B, Zakerihamidi M. The correlation between frequency and duration of breastfeeding and the severity of neonatal hyperbilirubinemia. J Matern Fetal Neonatal Med. 2018 Feb;31(4):457-463. doi: 10.1080/14767058.2017.1287897. Epub 2017 Feb 28. PMID: 28139952.
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