Jaundiced Newborn

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DEFINITION

• The skin and whites of the eyes have turned yellow.

Types of Jaundice

Physiological jaundice (50% of newborns)  

• Onset 2 to 3 days of age
• Peaks day 4 to 5, then improves
• Disappears 1 to 2 weeks of age

Breastfeeding jaundice (5 to 10% of newborns)

• Due to inadequate intake of breastmilk
• Pattern similar to physiological type

Breastmilk jaundice (1% of newborns)

• Due to substance in breastmilk which blocks destruction of bilirubin
• Onset 4 to 7 days of age
• Lasts 3 to 10 weeks
• Not harmful

Rh and ABO blood group incompatibility

• Onset during first 24 hours of life
• Can reach harmful levels

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WHEN TO CALL YOUR DOCTOR

Call 911 Now (your child may need an ambulance) If

• Unresponsive or difficult to awaken
• Not moving or very weak

Call Your Doctor Now (night or day) If

• Newborn starts to look or act sick (e.g., decrease in activity or ability to suck).
• Signs of dehydration (very dry mouth, sunken soft spot, no urine in 8 hours).
• Fever above 100.4°F (38.0°C) rectally.  
• Low temperature below 96.8° F (36.0°C) rectally.  
• Jaundice began during the first 24 hours of life.
• Skin looks deep yellow or orange
• You think your child needs to be seen

Call Your Doctor Within 24 Hours (between 9 am and 4 pm) If

• You are concerned your baby is not getting enough breastmilk.
• Good-sized yellow, seedy stools are less than 3 per day. (EXCEPTION: not valid until breastmilk comes in on day 4 or 5)
• Wet diapers are less than 6 per day. (EXCEPTION: 2 wet diapers/day can be normal until milk comes in on day 4 or 5)
• Discharged before 48 hours AND 4 or more days old AND hasn't been examined since discharge (Reason: AAP recommends re-check)
• Blood type problem (ABO, Rh) present
• You have other questions and concerns

Call Your Doctor During Weekday Office Hours If

• Color gets deeper after 7 days old.  
• Jaundice is not gone after 14 days of age. 
• Jaundice began or reappeared after 7 days of age.
• Stools are white, pale yellow or gray.

Parent Care at Home If

• Normal jaundice of newborn and you don't think your child needs to be seen.

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HOME CARE ADVICE FOR MILD JAUNDICE

1. Bottlefed:  If bottle fed, increase the frequency of feedings.  Try for an interval of every 2 to 3 hours during the day.
2. Breastfed:  If breastfed, increase the frequency of feedings.  Nurse your baby every 1½ to 2½ hours during the day.  Don't let your baby sleep more than 4 hours at night without a feeding.
3. Increase stools:
   • If your baby is 5 days or older AND has less than 3 stools/day, carefully insert a lubricated thermometer ½ inch (12 mm) into the anus and gently move it from side to side a few times to stimulate a stool
   • Reason: increased stools carry more bilirubin out of the body.
   • Do this once or twice per day until jaundice improves or stool frequency becomes normal.
4. Expected Course:   Physiological jaundice peaks on day 4 or 5 and then gradually disappears over 1-2 weeks.
5. Judging Jaundice:
   • View your baby unclothed in natural light near a window.
   • Press on the yellow skin on the chest with a finger to remove the normal skin tone.
   • Then assess the jaundice color before the pink color returns.
6. Call Your Doctor If:
   • Jaundice not gone by day 14
   • Your baby is not getting enough milk. (needs a weight check)
   • Your baby starts to act sick
   • Your child becomes worse

And remember, contact your doctor if your child develops any of the "Call Your Doctor" symptoms.

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