The majority of infants during the first few days of life will develop some degree of jaundice caused by an excess of the chemical bilirubin in the bloodstream and body tissues. The term jaundice refers to the yellow-orange color that is first noted in the eyes, and then noted in the skin. Bilirubin is a by-product of the breakdown of red blood cells, which are constantly being replenished. Newborn infants have a limited ability to eliminate bilirubin from the body, which frequently leads to a visible accumulation. These infants must be monitored carefully, primarily because of the risk of becoming lethargic and dehydrated. In very rare instances excessive jaundice can cause a condition called kernicterus, where bilirubin damages nervous tissue. Thankfully kernicterus can almost always be prevented with appropriate care.
The following is a partial list of factors that may increase the chances of more severe jaundice developing in the newborn period. Please note that some babies with one or more of these risk factors will not even develop visible jaundice:
- Premature birth.
- Visible jaundice appearing at less than 24 hours of age.
- Bruising or hematoma on the head caused by the birth process.
- Breast feeding.
- Infants born to mothers with Rh negative blood or type O blood.
The American Academy of Pediatrics (AAP) published revised guidelines in July of 2004 to address the prevention and management of jaundice in newborns. The following are highlights from those published guidelines:
- The AAP strongly recommends breastfeeding for all healthy term and near term babies.
- Clinicians should advise mothers to nurse their infants 8 to 12 times for the first several days. Routine supplementation with water or glucose water will not prevent jaundice.
- Pregnant women should be tested for ABO and Rh blood types. Based on those results, selected newborns should have their blood tested for ABO, Rh, and Coombs reaction.
- Newborns should be carefully monitored for the development of jaundice. Those with visible jaundice should have bilirubin levels measured and repeated as necessary.
In most cases jaundiced infants need nothing more than careful observation and successful establishment of breast or formula feeding. Exposure to sunlight may be helpful, however, the risk of sunburn must be weighed against any benefit. When taking into account their age, bilirubin level, and other factors, some infants will require treatment with phototherapy. This can usually be done at home. Those infants with significant dehydration or higher levels of jaundice may need hospital admission for successful treatment. In very unusual circumstances exchange transfusion may be required.
To learn more about hyperbilirubinemia, go to the AAP website (www.aap.org) in our links.