Jaundice in Newborns (Hyperbilirubinemia)

Symptoms

The most common symptom of jaundice in newborns is a yellowish tinge to the skin, the white part of the eyes, or the inside of the mouth. This yellow tint usually appears first in the infant's face and chest between 1 and 5 days after birth, although the exact timing may vary by child and by the type of jaundice.

• Physiologic jaundice develops in all babies (although it may be very slight and not noticeable) sometime after the first day of life. It occurs because babies' organs are not yet able to get rid of excess bilirubin effectively. If noticeable, the yellowing of the skin and eyes usually appears about 24 hours after birth and increases until about the third or fourth day. Most often, the blood bilirubin level then gradually lowers, and the yellowing fades or disappears in about a week without causing problems.
• Breast-feeding jaundice is caused by mild dehydration, which prolongs and intensifies physiologic jaundice. Dehydration contributes to jaundice because it makes removing bilirubin from the body even harder for babies' immature systems. Breast-feeding jaundice can occur when a baby does not get enough fluids, most often because feedings are spaced too far apart. Typically, if feedings become more frequent, this type of jaundice decreases or resolves sometime between 5 and 7 days after birth.
• Breast milk jaundice is a rise in bilirubin levels that occurs about 10 to 14 days after birth. It is likely related to how certain components of breast milk affect bilirubin elimination in the infant. Breast milk jaundice usually begins to fade by the second month, although a slight yellow tint may be visible throughout the duration of breast-feeding.

In rare cases, jaundice in a newborn may be caused by an underlying condition. Symptoms that begin to appear less than 24 hours after birth are unlikely to be jaundice and need to be evaluated carefully for other possible causes.¹

In general, call your health professional if the yellowing appears to increase after your baby's third day of life or has not decreased by the fifth day. Remember, however, that if you are breast-feeding, increasing the frequency of feedings may help to lower your baby's bilirubin levels and decrease jaundice.

Brain damage (kernicterus) can develop if a baby with a high bilirubin blood level is not treated. See your health professional right away if your baby develops signs of a high bilirubin level, which include:

• Sluggishness and poor sucking ability.
• Irritability, jitteriness, and crying.
• Arching of the baby's back.
• A shrill, high-pitched cry.

Signs of a very high level of bilirubin may include:

• Periods of not breathing (apnea) or difficulty breathing (dyspnea).
• Seizures.

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Author:	Debby Golonka, MPH	Last Updated: May 27, 2008
Medical Review:	Michael J. Sexton, MD - Pediatrics Thomas Emmett Francoeur, MDCM, CSPQ, FRCPC - Pediatrics
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