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  • Jaundiced Newborn

    Definition

    • Jaundice in a baby during the first months of life
    • The skin and whites of the eyes have turned a yellow color

    Causes 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 or Malnutrition jaundice (5 to 10% of newborns)

    • Due to inadequate intake of breastmilk
    • Pattern similar to physiological type
    • Also, causes poor weight gain

    Breastmilk jaundice (10% of newborns)

    • Due to substance in breastmilk which blocks destruction of bilirubin
    • Onset 4 to 7 days of age
    • Lasts 3 to 12 weeks
    • Not harmful

    Rh and ABO blood group incompatibility (Rare)

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

    When to Call Us for Jaundiced Newborn

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

    • Can’t wake up
    • Not moving or very weak
    • You think your child has a life-threatening emergency

    Call Us Now (night or day) If:

    • Age under 1 month old and looks or acts abnormal in any way
    • Feeding poorly (such as poor suck, does not finish)
    • Hard to wake up
    • Dehydration suspected. (No urine in over 8 hours, dark urine, very dry mouth and no tears)
    • Fever (Caution: Do NOT give your baby any fever medicine before being seen)
    • Low temperature below 96.8° F (36.0° C) rectally that doesn’t respond to warming
    • Jaundice began during the first 24 hours of life
    • Skin looks deep yellow or orange
    • Jaundice has reached the legs
    • Jaundice worse than when last seen
    • You think your child needs to be seen urgently

    Call Us Within 24 Hours (between 9 am and 4 pm) If:

    • You think your child needs to be seen, but not urgently
    • High-risk baby for severe jaundice. (Risk factors are: premature baby born at 36 weeks or less, ABO or Rh blood group problem, sib needed bili-lights, bleeding in the scalp, Asian race, breastfeeding problems)
    • You are worried about the amount of jaundice
    • You are worried your baby is not getting enough breastmilk
    • Yellow, seedy stools are less than 3 per day. (Exception: breastfed and before 5 days of life)
    • Day 2-4 of life and no stool in over 24 hours and breastfed
    • Wet diapers are less than 6 per day. (Exception: 3 wet diapers per day can be normal before 5 days of life if breastfed)
    • 4 or more days old AND has not been checked since discharge
    • You have other questions or concerns

    Call Us During Weekday Office Hours If:

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

    Parent Care at Home If:

    • Mild jaundice of newborn

    Care Advice for Mild Jaundice

    What You Should Know:

    • Some jaundice is present in 50% of newborns.
    • It lasts a short time and will go away. Most often, it is harmless.
    • The first place for jaundice to start is in the whites of the eyes.
    • Jaundice that is only of the face and eyes is always harmless.
    • Here is some care advice that should help.

    Bottlefed:

    • If bottle fed, increase how often you feed your baby.
    • Try to feed every 2 to 3 hours during the day.
    • Don’t let your baby sleep more than 4 hours at night without a feeding.

    Breastfed:

    • If breastfed, increase how often your feed your baby.
    • Nurse your baby every 1½ to 2 hours during the day.
    • Don’t let your baby sleep more than 4 hours at night without a feeding.
    • Goal: At least 10 feedings every 24 hours.

    Increase Stools:

    • If your baby is 5 days or older AND has less than 3 stools per day, try to increase stools. Do this by carefully putting a lubricated thermometer into the anus. Put it in no more than ½ inch (12 mm). Then, gently move it from side to side a few times. This will help your baby pass a stool.
    • Reason: Increased stools carry more bilirubin out of the body.
    • Do this once or twice per day until jaundice improves. Also, do this until stool frequency becomes normal.

    What to Expect:

    • Physiological jaundice peaks on day 4 or 5.
    • It slowly goes away over 1-2 weeks.

    Judging Jaundice:

    • Jaundice starts on the face and moves downward. Try to determine where it stops.
    • View your baby unclothed in natural light near a window.
    • Press on the skin with a finger to remove the normal skin tone.
    • Then try to look if the skin is yellow before the pink color returns.
    • Move down the body, doing the same. Try to look where the yellow color stops.
    • Jaundice that only involves the face and eyes is always harmless. As it involves the chest, the level is going up. If it involves the stomach, arms or legs, the bilirubin level needs to be checked.

    Call Your Doctor If:

    • Jaundice gets worse
    • Legs turn yellow
    • Feeds poorly or has a weak suck
    • Baby starts to look or act abnormal
    • Jaundice lasts more than 14 days

    Disclaimer: This information is not intended be a substitute for professional medical advice. It is provided for educational purposes only. You assume full responsibility for how you choose to use this information.

    Author and Senior Reviewer: Barton D. Schmitt, M.D.
    Copyright 1994-2013 Barton D. Schmitt, M.D.

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