Infant Jaundice. Information for mothers of new babies from a pediatrician

What is infant 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.

What causes infant jaundice?

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 most likely cause is:

Breast Milk jaundice

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.

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. About 15 % of all healthy breast-fed infants will have jaundice.

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.

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, phototherapy may be needed.

If your baby is still jaundiced at 3 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 can cause jaundice - it also causes 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 3 weeks of age is due to breast milk jaundice but tests are important to identify the few babies who will have biliary atresia and need surgery.

When should I be worried?

See your doctor if your jaundiced baby:

is very lethargic and not feeding
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

References

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

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Last reviewed 24 September 2007

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