Infant Jaundice

Infant jaundice is common in newborn babies. It is when the whites of the eyes and skin look yellow. Most causes are benign but there are some serious causes.

This page answers these questions:

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What is jaundice?

Jaundice refers to a yellow coloration of the skin and the whites of the eyes. The yellow color is due to bilirubin, a bile pigment, building up in the skin.

Initially, when the bilirubin level is only moderately elevated, you will only notice infant jaundice in the white of the eyes. As the level rises, you will notice yellow (jaundice) on the chest and then on the abdomen as well. When levels get very high, even the feet and hands will look yellow.

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What causes jaundice in babies?

The cause depends on how soon after birth your baby got jaundiced.

  • If your baby became jaundiced in the first 24 hours after birth, the most likely causes are:
    • ABO blood group incompatibility between mother and baby - for example, mother is O blood group and baby is A - this causes blood cells to break down and extra bilirubin spills out from the blood cells
    • Rhesus incompatibility between mother and baby - for example, mother is Rhesus negative blood group and baby is Rhesus positive - this causes blood cells to break down and extra bilirubin spills out from the blood cells
    • Infection in your baby
  • If your baby became jaundiced after 24 hours and within 2 weeks of birth, the most likely causes are:
    • Physiological jaundice - this is just part of being a normal baby
    • Breast-milk jaundice - this occurs in breast-fed babies and is an exaggeration of physiological jaundice
  • If your baby became jaundiced after 2 weeks of birth, the cause could be:
    • Breast Milk jaundice - this is most likely
    • A liver problem
    • A blockage of the bile tracts known as biliary atresia
    • Underactive thyroid known as hypothyroidism
    • Another disease process such as cystic fibrosis

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Why do babies get jaundice?

Babies have an immature liver enzyme system which means they don't handle the bilirubin pigment so efficiently and this makes them prone to jaundice - which we call physiological jaundice.

Breast-milk contains substances that make it even harder for the liver so that is why breast-milk jaundice occurs.

Anything that stresses the body, like infection, will also cause jaundice.

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Should I stop breast-feeding my jaundiced infant?

No. Breast-feeding is the best gift you can give your baby. Although, it can make babies more jaundiced for longer, there are no problems that result from the jaundice in most cases. About 15 % of all healthy breast-fed infants will have jaundice.

If you are breast-feeding your baby, particularly if your baby was born early, the best thing you can do is feed your baby regularly over the first few days, so feed every 3 hours. This prevents babies getting dehydrated which can make jaundice worse.

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Does infant jaundice need treatment?

If jaundice occurs in the first 24 to 48 hours after birth, treatment is nearly always necessary.

After the first couple of days, treatment will only be required for very high levels of bilirubin in the blood - you health care provider will probably do a blood test to check the level.

The most usual treatment is phototherapy, which means your baby receives a special wave-length of ultraviolet light which breaks down the bilirubin in the skin.

If the infant jaundice is due to a disease process, then specific treatment of that process will be necessary.

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When do babies with jaundice need tests?

Your baby will need a bilirubin level if the jaundice seems severe - this can be just a pinprick test or a normal blood test. If the level is high and of the unconjugated type, phototherapy may be needed.

If your baby is still jaundiced at 2 weeks, blood tests will often be organised to check your baby doesn't have a condition called biliary atresia - this is when the biliary tract is not properly formed and it causes jaundice and pale stools (poop, poo). This condition requires surgery and this must be done in the first 2 months of life to be successful.

Most infant jaundice still present at 2 weeks of age is due to breast milk jaundice but tests are important to identify the few babies who will have biliary atresia (and so need work-up for surgery) or other conditions.

If the blood tests show that the type of bilirubin that is raised is conjugated, then further tests will be necessary.

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When should I be worried?

See your doctor if your jaundiced baby:

  • is very lethargic and not feeding
  • is becoming more noticeably jaundiced over the first few days, particularly if the body looks yellow and especially if the hands and feet look yellow
  • has pale colored stools (poop, poo) - he may have a rare liver condition with obstruction of the bile tree (biliary atresia) and this needs immediate attention
  • is unwell in any other way
  • is still jaundiced at 2 weeks of age (14 days)

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References

Lissauer T, Clayden G. Illustrated Textbook of Paediatrics. Mosby 1999.

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Last reviewed 31 August 2011

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Dr Maud MD

Dr Maud MD (MBChB, FRACP, FRCPCH), a specialist pediatrician, provides health information and medical advice for parents of babies and toddlers. Read more about Dr Maud.


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