Babies are born with extra red blood cells. As the extra red blood cells break apart, they release bilirubin molecules. Your baby's immature liver can't handle all these molecules, so they accumulate in your baby's blood stream. It's common for your baby's skin to turn a bit yellow, but excessive bilirubin levels cause serious problems. It's routine basic healthcare to closely monitor your baby's skin color and bilirubin levels, and treat the jaundice when necessary.
Jaundice (skin yellowness) and bilirubin numbers
- Normal jaundice starts after 24 hours of life, with yellowness appearing first in the face.
- In most newborns, the bilirubin numbers in the blood increase just a little over the first 4 days of life.
- The yellowness progresses down their body as bilirubin levels rise.
- In some babies, the bilirubin number increases quickly and requires treatment with ultraviolet light, called phototherapy.
- The treatment number depends on hours of life, and on risk factors like incompatible blood types between you and your baby, prematurity, health issues, bruising, heredity, etc.
- After around day 5, bilirubin numbers naturally decline. Yellowness fades, with the face staying yellow the longest.
- As long as your baby gains weight and is otherwise healthy, bilirubin numbers gradually decline, unless there is breastmilk jaundice.
Breastmilk Jaundice stays a while
- Exclusively breastfed newborns sometimes stay yellow for a few weeks, due to factors in the breastmilk that affect bilirubin metabolism.
- Using formula to treat breastmilk jaundice is rarely recommended.
- If breastmilk jaundice is suspected, some may suggest formula for 12-24 hours, to see if bilirubin levels will quickly decline. If they do, you can resume breastfeeding.
- A couple more blood tests will also confirm the liver is working, and there are no blood incompatibility issues.
- The benefits of breastmilk outweigh the inconvenience of dealing with breastmilk jaundice.
Things that might help jaundice
- Nurse at least every 3 hours, start to start, plus on demand, as hydration and pooping helps.
- Monitor your baby's weight loss closely over the first 4 days.
- Get a weight check to be sure your baby gains 1 ouncer per day after day 4.
- If needed, supplement with your pumped milk, donor milk, or formula.
- Do not feed water.
- Sunlight doesn't hurt anything, but if bilirubin numbers reach treatment levels, phototherapy is required.
Phototherapy
Ultraviolet light shined onto your baby’s skin helps metabolize bilirubin. The light comes from an overhead lamp or from coils of light embedded in fabric placed on your baby's bare skin. This can often be accomplished in your home, but sometimes hospitalization is required. Daily blood tests determine when the treatment can stop, which is typically after a day or two.- Make sure someone always reports the blood test results and gives you further instructions each day.
Abnormal jaundice is very rare
When bilirubin levels rise quickly, additional simple blood tests are done. These tests make sure there is no incompatibility between your and your baby's blood types, and that your baby's liver is healthy.Kay Andersonm MD, IBCLC
5/23