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Hyperbilirubinemia (Neonatal Jaundice)

Neonatal Jaundice describes the yellow coloring of the skin and whites of the eyes. It is often seen the first 3-7 days after birth. The yellow color comes from a build up of bilirubin in the blood, which occurs when red blood cells break down (all babies are born with extra red blood cells). When the newborn’s immature liver is unable to get rid of the bilirubin fast enough, the skin becomes yellow. As the baby’s liver matures and the body gets rid of the extra bilirubin, the jaundice goes away. Your baby gets rid of the bilirubin in his stool. Some babies do not get jaundiced at all, while other babies become very jaundiced and need help getting rid of the bilirubin.

What can cause neonatal jaundice?

  • Poor feeding, which can lead to dehydration
  • Being born a few weeks early / prematurity
  • Bruising or internal bleeding during delivery
  • Infection
  • Immature liver function (common in newborns)
  • Blood type difference between mother and baby that sometimes can lead to antibodies that break down the baby’s red blood cells

What are the symptoms of neonatal jaundice?

  • The whites of your baby’s eyes become yellow or his/her skin has a yellow or orange color (Some people think their baby looks like he has a tan)
  • Your baby is very sleepy or very floppy (like a rag doll)
  • Low temperature
  • Irritability/ fussiness (Your baby cries a lot and you have trouble calming him)
  • Feeding problems (especially if you have trouble getting your baby to awaken to feed)

Call the doctor or health care provider if you see any of the symptoms listed above after your baby comes home from the hospital.

How is neonatal jaundice treated?

Mild Jaundice:

  • If you are breastfeeding you will need to feed your baby more frequently. Do not wait until your baby cries to feed him. Crying is a late sign of hunger. Feed your baby whenever he shows signs of hunger such as:
    • bringing his hands to the mouth to suck on them
    • turning his head whenever the side of his face is touched
    • moving around more Aim to feed about 10-12 times a day. Do not supplement with formula or other fluids unless your doctor or health care provider has told you to do this.
  • If you are formula feeding, you will need to give your baby extra formula. Do not wait for your baby to start crying before you feed him. Do not give your baby other fluids unless instructed by the doctor.
  • Call your baby’s doctor if you notice that his symptoms are getting worse.
  • It is very important that you bring your baby back to the doctor’s office for all scheduled follow-up appointments. Your baby may need to have a small amount of blood drawn for lab tests to check the bilirubin level.

Moderate or Severe Jaundice:

In addition to the information for mild jaundice the following may be done:

  • Your baby will need a blood test to check the bilirubin level.
  • If the bilirubin level is too high, your baby will be placed under phototherapy (special high intensity light) to help speed up the removal of bilirubin from the blood. There is also a ‘bili blanket’ which is a pad with similar high intensity lights. The light converts the bilirubin to a form that can be eliminated in the urine.
  • If your baby receives phototherapy in the hospital he will be nude and have his eyes protected with a mask. The lights will shine on the baby and he may be kept warm by placing him in an incubator. It is important that your baby stay under the light as much as possible. The need for the lights may limit the amount of time you can hold your baby.
  • Your baby may have frequent, loose, dark green seedy or black stools. Bilirubin is carried out of the body in stools, so frequent bowel movements can be helpful. Sometimes glycerin suppositories are used to help your baby to stool. Do not use suppositories at home unless your doctor recommends this for your baby.
  • Your baby will get a blood test to check the bilirubin level each day that he is receiving phototherapy. Once the level is low enough, he will no longer need the blanket or lights.
  • An exchange blood transfusion may be needed if the bilirubin level gets very high. This treatment is rarely needed.
    • A catheter is placed in the umbilical cord stump to give the transfusion.
    • Slowly, small amounts of blood will be removed and replaced with the same amount of donor blood. This removes the blood that has high levels of bilirubin.
Please ask your baby's doctor or nurse if you have any questions.

Disclaimer: This information is not intended to substitute or replace the professional medical advice you receive from your child's physician. The content provided on this page is for informational purposes only, and was not designed to diagnose or treat a health problem or disease. Please consult your child's physician with any questions or concerns you may have regarding a medical condition.

Reviewed: 06/2011