Days after giving birth, you hold your perfect baby while your pediatrician examines her from head to toe. Everything checks out fine, until she presses on the tip of your baby's nose and releases it, revealing yellowish-tinged skin. Your baby is jaundiced, she says, and needs to be monitored closely for the next two weeks.

Should you be worried?

Like most parents, you probably will worry whether you should or not. Luckily, most cases of jaundice go away without therapy. To be on the safe side, pay attention to your doctor's advice and keep close tabs on your baby's color. Time is of the essence when diagnosing and treating jaundice.

"The recommendations are that if you are going home from the hospital within the first 24 or 36 hours of age, your baby should be seen by a doctor by the third day of life," says Dr. Brenda Morris, M.D., associate professor of pediatrics at The University of Texas Medical School at Houston.

Hello, Yellow

Babies become jaundiced when levels of a substance called bilirubin increase in their blood, a condition called hyperbilirubinemia.

Bilirubin is a waste product made when hemoglobin in red blood cells breaks down. This type of bilirubin is called unconjugated, or indirect. Normally, the bilirubin is transferred from the blood into the liver, and then the liver cells attach or conjugate it to another molecule, and excrete it with the bile flowing from the liver. Babies then eliminate the conjugated, or direct bilirubin in their stool.

When a newborn's liver isn't able to process bilirubin fast enough, the pigment builds up in the baby's blood and her skin and eyes appear yellowish.

What is Normal?

More than half of all healthy babies develop the most common type of jaundice, called physiologic jaundice. Physiologic jaundice develops two to three days after birth, peaks at about four to five days, and normally goes away within two weeks of birth.

This type of jaundice is more common in Asian babies and babies who are exclusively breastfed. Jaundice may be exaggerated by breastfeeding when a mother's milk supply is becoming established.

Since mild jaundice is so common in newborns, doctors speculate that it must have some useful purpose.

"A mild rise in a baby's bilirubin levels is considered a normal phenomenon and may be considered beneficial," Morris says. "Bilirubin is an antioxidant, and may be one of the ways that babies fight off antioxidant stress in the first week of life."

Jaundice that can hurt a baby or is a symptom of a more serious condition is called pathologic jaundice. Many conditions including blood group incompatibilities, red blood cell diseases, liver diseases, infections, prematurity and dehydration can cause pathologic jaundice.

Signs and Symptoms

The skin of a jaundiced baby usually starts to look yellow a few days after birth, a time when most babies are home from the hospital. But not all newborn babies who develop the condition are bright, banana yellow. Some may have only a slight yellowish cast to their skin, or look tan or olive-colored.

"In darker-skinned infants it can be hard to tell if they are jaundiced," Morris says. "It is always a good idea to have a doctor test your child if you are concerned."

Jaundiced babies may also have a greenish cast to the whites of their eyes. They may fall asleep frequently when eating and sleep more often than normal babies. Since it is difficult to estimate the degree of jaundice by appearance alone, the only true way to determine the severity of jaundice is to test a baby's blood for her bilirubin levels.

The blood of all healthy babies and healthy adults contains some bilirubin. Physiologic jaundice occurs when total serum bilirubin accumulates to a level greater than approximately 2.5 milligrams per deciliter of blood and up to 17 milligrams per deciliter of blood. Direct bilirubin that is higher than1milligram per deciliter of blood may be a sign of a liver problem.

Testing a baby's total bilirubin is standard, however doctors should test direct bilirubin to rule out other causes of jaundice if they are uncertain about the diagnosis.

Out with the Bad, In with the Good

To get your baby back in the pink, keep the breast milk or formula flowing, Morris advises.

"When babies are not getting enough in, they don't have as many bowel movements," she explained. "That black tarry stuff you see in a newborn's diapers, called meconium, which contains lots of bilirubin, is reabsorbed into the body and causes jaundice." Feeding your baby more frequently helps him or her excrete the meconium and prevents dehydration.

If bilirubin levels are high, your doctor may recommend admitting your baby to the hospital for phototherapy. Your baby will be placed under artificial lights, in a covered hospital bassinet or open warmer. The lights change the structural configuration of the bilirubin, so that your baby can get rid of it through urination.

Treatment for pathologic jaundice varies, depending on the disease or disorder that is causing the jaundice. In severe cases of pathologic jaundice, doctors perform an exchange transfusion to replace the baby's problem blood with compatible blood.

Should I Worry?

While most cases of jaundice go away after one to two weeks, parents and doctors should monitor babies with jaundice closely. In cases of severe pathologic jaundice or rapidly climbing bilirubin levels, bilirubin may accumulate in the brain and cause brain damage, a condition called kernicterus. Diagnosing and treating jaundice early can prevent this condition from developing.

Jaundice that doesn't go away can also be the symptom of a liver disease, especially if you notice that your baby's dirty diapers are pale or clay colored instead of yellow or greenish–brown, and her urine is burnt orange or dark instead of straw colored. The color of the stool is often lighter in babies with liver disease because the liver is not excreting bilirubin, which is yellow in pigment.

Diseases and conditions that may cause jaundice in infants include viral hepatitis, autoimmune hepatitis, hemolytic anemia, cystic fibrosis and genetic disorders that cause problems processing bilirubin.

Conditions that damage or block the bile ducts, such as biliary atresia or cysts, cause jaundice because the liver is unable to excrete the bile. Jaundice is also a symptom of galactosemia, a rare, hereditary disease caused by elevated levels of a milk sugar called galactose, which the liver is unable to process.

If your baby has been jaundiced for more than two weeks and your doctor has not yet tested her direct bilirubin, speak up.

"Mild jaundice is not a cause for alarm, but pathologic or sustained jaundice should be tested for and needs to be treated quickly," Morris says.

Last Updated: 7-19-2004

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