As I am opening a new pediatric practice, I am seeing lots of newborns and reviewing jaundice frequently. If your kids are older, feel free to skip this article, or think about that little baby you used to have and say, “Phew, glad I don’t have to worry about that anymore!”
Jaundice is a condition where the skin turns yellow. There are many causes of jaundice in adults, but in newborns, it is usually simpler. Jaundice comes from the build-up of bilirubin in the blood. Bilirubin is red pigment that is found in bile that can be released with the breakdown of heme-containing compounds such as hemoglobin (aka red blood cells).
Jaundice in newborns occurs through two main pathways: There is too much bilirubin being produced or there is a problem with the normal way to clear the bilirubin.
Nearly every baby has “physiologic” or normal jaundice. In physiologic jaundice, newborns normally have rapid breakdown of red blood cells after birth, which dumps more bilirubin into the blood and their liver is immature. Also, the proteins which will eventually allow the liver to process the bilirubin are not as available. Instead of being cleared through normal paths, the bilirubin deposits in the tissues – skin, whites of the eyes, etc.
There are some babies who have more than physiologic jaundice. Premature babies are more likely to have high levels of jaundice. Babies with genetic or other predispositions may have more severe jaundice. Babies can have problems with clearing bilirubin because of an anatomic abnormality (think liver or gallbladder problems—these are super rare and cause a specific type of jaundice that would be picked up by the doctor with common blood tests, usually).
A more common reason babies have high levels of bilirubin is the breastfeeding baby who is having some trouble getting enough milk, either because mother’s milk isn’t in or the baby isn’t latching well, or some other reason. I love moms who breastfeed – it is super awesome for mom and for baby! But sometimes babies are slow to get going. And if there isn’t milk going through the gut to stimulate bile release, the baby may be more likely to develop breastfeeding jaundice.
So what? One of the tissues where bilirubin is deposited is the brain. Bilirubin deposited in the skin doesn’t cause major problems or lifelong yellowness, but bilirubin can become toxic when it is deposited in the brain. These deposits happen when the bilirubin level is very high. It can cause problems with seizures, muscle tone problems or hearing loss.
Luckily, these problems are very rare. Usually around 24 hours after birth, doctors test babies for bilirubin levels with a blood test or a skin test. We also assess a baby’s color and do follow-up testing if needed at their office visits after they are born. In the United States, approximately 1 in 650-1,000 late preterm or term infants develop high bilirubin levels. Incidence of neurological problems from the very high bilirubin levels is far lower, on the order of 1 in 27,000 to 1 in 55,000 babies.
How do we know when bilirubin is too much? Doctors review graphs that give risk zones based on hours a baby is old. These help to stratify the babies and also to help us decide which babies need phototherapy – the primary treatment of hyperbilirubinemia today. Also known as bili lights, phototherapy uses light therapy to change the structure of bilirubin in the skin to make it water soluble so that the baby can urinate it out.
The good news is that most bilirubin problems go away quickly. It can feel like eternity when it is your little one, but it usually passes without complication. Frequent feedings, lots of love and scheduled follow-ups with your doctor can keep everything on track.
Be flexible, be smart and be patient. You can do this.
Katie Jackson is a pediatrician at Utica Park Clinic Claremore.