Phototherapy is not indicated for conjugated hyperbilirubinemia. Formula-fed infants usually should have 1 to 2 ounces (about 30 to 60 milliliters) of formula every two to three hours for the first week. In this setting, phototherapy may cause a dark grayish-brown discoloration of the skin (bronze baby syndrome).2 Potential problems that may occur with phototherapy include burns, retinal damage, thermoregulatory instability, loose stools, dehydration, skin rash, and tanning of the skin. Don't miss your FREE gift. is looking more yellow, especially if it is spreading down below the knees, is feeding poorly, and/or isnt wetting at least six diapers in 24 hours and having regular stools, is very sleepy, especially if they dont wake to feed, arches their head or back, or is otherwise acting strangely. A good way to look for it is to press down for a moment on the babys skin in a spot where the bone is close (the forehead, nose, chest, or shin are good places to do this). Neonatal dermal icterus is not noticeable at total serum bilirubin levels below 4 mg per dL (68 mol per L).16. If a baby has severe jaundice, there's a risk of bilirubin passing into the brain, a condition called acute bilirubin encephalopathy. On most babies who are jaundiced, we can check a bilirubin level in our office. Web(2) Total serum bilirubin level is less than 12 mg/ 100 mL (205.05 umol/L). Because adult donor RBCs have more ABO antigen sites than fetal cells, type-specific transfusion will intensify the hemolysis. Improving Newborn Preventive Services at the Birth Hospitalization: A Collaborative, Hospital-Based Quality-Improvement Project. The goal is to reduce bilirubin by nearly 50%, with the knowledge that hyperbilirubinemia may rebound to about 60% of pretransfusion level within 1 to 2 hours. Family history should note known inherited disorders that can cause jaundice, including glucose-6-phosphate dehydrogenase (G6PD) deficiency, or other red cell enzyme deficiencies, thalassemias, and spherocytosis, and also any history of siblings who have had jaundice. Infant jaundice is yellow discoloration of a newborn baby's skin and eyes. MEREDITH L. PORTER, CPT, MC, USA, AND BETH L. DENNIS, MAJ, MC, USA. Therefore, history should include what the infant is being fed, how much and how frequently, urine and stool production (possible breastfeeding failure or underfeeding), how well the infant is latching on to the breast or taking the nipple of the bottle, whether the mother feels that her milk has come in, and whether the infant is swallowing during feedings and seems satiated after feedings. Picco MF (expert opinon). A less serious side effect that may occur from jaundice is sleepiness in the newborn. Mayo Clinic on Incontinence - Mayo Clinic Press, NEW Mayo Clinic on High Blood Pressure - Mayo Clinic Press, Mayo Clinic on Hearing and Balance - Mayo Clinic Press, FREE Mayo Clinic Diet Assessment - Mayo Clinic Press, Mayo Clinic Health Letter - FREE book - Mayo Clinic Press, Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic School of Continuous Professional Development, Mayo Clinic School of Graduate Medical Education, Book: Mayo Clinic Family Health Book, 5th Edition, Newsletter: Mayo Clinic Health Letter Digital Edition. The American Academy of Pediatrics recommends that newborns be examined for jaundice during routine medical checks and at least every eight to 12 hours while in the hospital. Infant jaundice usually occurs because a baby's liver isn't mature enough to get rid of bilirubin in the bloodstream. The presence of jaundice can be determined by examining the infant in a well-lit room and blanching the skin with digital pressure to reveal the color of the skin and subcutaneous tissue. Mayo Clinic is a not-for-profit organization. Call your doctor if: There is a problem with Lungs are examined for crackles (rales), rhonchi, and decreased breath sounds (pneumonia). Improve your flexibility and balance so you dont fall? Make sure your baby is having at least six diapers daily. Click here for an email preview. The more preterm the infant, the lower the threshold ( see Table: Suggested Thresholds* for Starting Phototherapy or Exchange Transfusion in Infants < 35 Weeks Gestation Suggested Thresholds* for Starting Phototherapy or Exchange Transfusion in Infants < 35 Weeks Gestation ). Biliary atresia. If your baby has jaundice, your doctor will assess the likelihood of severe jaundice based on a number of factors: How much bilirubin is in the blood Whether your baby was born prematurely How well he or she is feeding How old your baby is Whether your baby has bruising from delivery Whether an older sibling also had severe jaundice Follow This is more than twice the production rate in adults, primarily because of relative polycythemia and increased red blood cell turnover in neonates.7 Bilirubin production typically declines to the adult level within 10 to 14 days after birth.2, Kernicterus refers to the neurologic consequences of the deposition of unconjugated bilirubin in brain tissue. Jaundice is best seen in natural light and can be harder to detect in dark-skinned babies. Accessed April 2, 2018. o [ abdominal pain pediatric ] Sign up for free, and stay up to date on research advancements, health tips and current health topics, like COVID-19, plus expertise on managing health. Eat smarter and reduce your risk for a heart attack? Evaluation of unconjugated hyperbilirubinemia in term and late preterm infants. information and will only use or disclose that information as set forth in our notice of The only consistently reliable estimation of total serum bilirubin occurs when dermal icterus is confined to above the nipple line. Some health care providers feel that placing a baby near a window where he/she can receive indirect sunlight can also help with mild cases of jaundice. Curbing nearsightedness in children: Can outdoor time help? Claire McCarthy, MD, is a primary care pediatrician at Boston Childrens Hospital, and an assistant professor of pediatrics at Harvard Medical School. This treatment can rapidly remove bilirubin from circulation and is indicated for severe hyperbilirubinemia, which most often occurs with immune-mediated hemolysis. include protected health information. Few term newborns with hyperbilirubinemia have serious underlying pathology. The serum bilirubin level required to cause jaundice varies with read more based on gestational age. It gets processed in the liver to make it easier for the body to get rid of through the urine and stool. Diseases or conditions that can cause jaundice include: Major risk factors for jaundice, particularly severe jaundice that can cause complications, include: High levels of bilirubin that cause severe jaundice can result in serious complications if not treated. However read more is the most severe form of neurotoxicity. WebFor well infants 35 - 37 6/7 wk, can adjust TSB levels for intervention around the medium risk line. Delayed meconium passage also increases the risk. At physiologic pH, bilirubin is insoluble in plasma and requires protein binding with albumin. Because transient jaundice is common among healthy neonates (unlike adults, in whom jaundice always signifies a disorder), hyperbilirubinemia can be classified as physiologic or pathologic. Previously, some clinicians used criteria based solely on patient weight, but these criteria have been replaced by the more specific guidelines described above. Substances in maternal milk, such as -glucuronidases, and nonesterified fatty acids, may inhibit normal bilirubin metabolism.5,7,14,15 The bilirubin level usually falls continually after the infant is two weeks old, but it may remain persistently elevated for one to three months. Critical hyperbilirubinemia is uncommon but has the potential for Review/update the "Mayo," "Mayo Clinic," "MayoClinic.org," "Mayo Clinic Healthy Living," and the triple-shield Mayo Clinic logo are trademarks of Mayo Foundation for Medical Education and Research. Before going home, you should receive written information about jaundice, information about your babys bilirubin level and other lab tests, and clear instructions about when the baby should see the pediatrician. In the presence of hemolytic disease, severe anemia, or a rapid rise in the total serum bilirubin level (greater than 1 mg per dL per hour in less than six hours), exchange transfusion is the recommended treatment. Evaluation should focus on distinguishing physiologic from pathologic jaundice. Hyperbilirubinemia is one of the most common problems encountered in term newborns. Phototherapy should be instituted when the total serum bilirubin level is at or above 15 mg per dL (257 mol per L) in infants 25 to 48 hours old, 18 mg per dL (308 mol per L) in infants 49 to 72 hours old, and 20 mg per dL (342 mol per L) in infants older than 72 hours. WebHey Mummas so the newborn snuggles have been amazing, recovery has been abit crappy but feeling better today. An increased incidence of kernicterus was found to be associated with total serum bilirubin levels above 20 mg per dL in the presence of hemolysis.19,20 This observation was the basis for aggressive guidelines recommending the use of exchange transfusion in all infants with significant hyperbilirubinemia. Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation, Pediatrics 2004, 114:297 For most babies, Assess all possible risks for jaundice: not just the mothers blood type but also gestational age, family history, any bruising, how early jaundice appears, and other factors. 2004 Jul;114(1):297-316. Phototherapy- Phototherapy is a light that helps break down the bilirubin in the babys skin. health information, we will treat all of that information as protected health Albumin-bound bilirubin may also cross the blood-brain barrier if damage has occurred because of asphyxia, acidosis, hypoxia, hypoperfusion, hyperosmolality, or sepsis in the newborn.3,8, The exact bilirubin concentration associated with kernicterus in the healthy term infant is unpredictable.1 Toxicity levels may vary among ethnic groups, with maturation of an infant, and in the presence of hemolytic disease. Hyperbilirubinemia can be caused by one or more of the following processes: Impaired bile flow (cholestasis Neonatal Cholestasis Cholestasis is failure of bilirubin secretion, resulting in conjugated hyperbilirubinemia and jaundice. Symptoms in infants include poor feeding and growth failure; symptoms in older children and adolescents are similar to those of adults but also read more. Competitive binders include drugs (eg, sulfisoxazole, ceftriaxone, aspirin) and free fatty acids and hydrogen ions (eg, in fasting, septic, or acidotic infants). Studies on the toxic effects of hyperbilirubinemia historically involved infants with hemolytic disease. Treatment depends on cause and degree of bilirubin elevation; the more preterm the infant, the lower the threshold level for treatment. Muchowski KE. Copyright 2023 American Academy of Family Physicians. Complications include perinatal asphyxia, meconium aspiration, polycythemia read more , and/or ill (eg, with sepsis Neonatal Sepsis Neonatal sepsis is invasive infection, usually bacterial, occurring during the neonatal period. 2 Severe hyperbilirubinemia Jaundice is actually a yellowing of the skin or whites of the eyes. This content does not have an English version. The serum bilirubin level required to cause jaundice varies with read more ). Small amounts of blood are withdrawn and replaced through an umbilical vein catheter, or other access as available, to remove partially hemolyzed and antibody-coated red blood cells (RBCs) as well as circulating immunoglobulins. WebAbout 2% of breastfed babies get jaundice. Phototherapy is the use of light to photoisomerize unconjugated bilirubin into forms that are more water-soluble and can be excreted rapidly by the liver and kidney without glucuronidation. Senior Faculty Editor, Harvard Health Publishing. Rarely, an unusually high blood level of bilirubin can place a newborn at risk of brain damage, particularly in the presence of certain risk factors for severe jaundice. Managing the jaundiced newborn: A persistent challenge. This late-onset jaundice may develop in up to one third of healthy breastfed infants.1 Total serum bilirubin levels vary from 12 to 20 mg per dL (340 mol per L) and are nonpathologic. The combination of these two factors is what makes jaundice so common. In preterm infants, hypothermia increases morbidity and mortality. For term infants, specific indications are serum bilirubin 20 mg/dL ( 342 micromol/L) at 24 to 48 hours or 25 mg/dL ( 428 micromol/L) at > 48 hours and failure of phototherapy to result in a 1- to 2-mg/dL (17- to 34-micromol/L) decrease within 4 to 6 hours of initiation or at the first clinical signs of kernicterus regardless of bilirubin levels. The skin is inspected for extent of jaundice. Breast-fed infants should have eight to 12 feedings a day for the first several days of life. In some babies, an underlying disease may cause infant jaundice. This issue may be caused by a substance in breastmilk. History of present illness should note age of onset and duration of jaundice. Want to reduce pain in your knees and be more active? WebJaundice is one of the most common conditions that can affect newborn babies. The following signs or symptoms may indicate severe jaundice or complications from excess bilirubin. The objective of the guidelines is to help detect and mange optimally significant hyperbilirubinaemia and to prevent very high levels of bilirubin, which can be harmful if not treated. b. For the head and neck examination, any bruising and swelling of the scalp consistent with a cephalohematoma are noted. Unconjugated hyperbilirubinemia in the newborn: Pathogenesis and etiology.https://www.uptodate.com/contents/search. Recommendations for the management of hyperbilirubinemia in healthy term newborns have been outlined by the American Academy of Pediatrics (Table 4).1 Jaundice in a term newborn fewer than 24 hours old is always pathologic: it should be investigated thoroughly and treated appropriately. https://www.uptodate.com/contents/search. Hay WW, et al., eds. WebApproximately 60% of term and 80% of preterm babies develop jaundice in the first week of life, and about 10% of breastfed babies are still jaundiced at 1 month. Known as jaundice, this condition is a very common and usually normal part of the newborn period. The baby is put under a special light (or wrapped in a special blanket with the light inside it) that helps the body get rid of bilirubin. For critically ill or premature infants, aliquots of 5 to 10 mL are used to avoid sudden major changes in blood volume. Wong RJ, et al. Babies should wet at least six diapers over a 24-hour period, and should have stools regularly. If the jaundice is mild and fades over the first few weeks-no treatment is needed. Bilirubin, which is responsible for the yellow color of jaundice, is a normal part of the pigment released from the breakdown of "used" red blood cells. It can cause athetoid cerebral palsy and hearing loss. Use for phrases But in some very rare cases it can lead to, or be a sign of, a more serious Shorter neonatal red blood cell life span increases bilirubin production, deficient conjugation due to the deficiency of uridine diphosphate-glucuronosyltransferase (UGT) decreases clearance, and low bacterial levels in the intestine combined with increased hydrolysis of conjugated bilirubin increase enterohepatic circulation. Before treatment is initiated, the minimum evaluation should include the infant's age and postnatal course, a maternal and gestational history, physical examination of the infant, and determination of the total serum bilirubin level and the rate at which it is rising (Figure 2).22, Phototherapy employs blue wavelengths of light to alter unconjugated bilirubin in the skin. Bilirubin mostly comes from the breakdown of red blood cells. Breastfeeding jaundice develops in one sixth of breastfed infants during the first week of life. Hyperbilirubinemia is very common and usually benign in the term newborn infant and the late preterm infant at 35 to 36 completed weeks gestation. One of the things that your care provider will be monitoring is jaundice. WebDoctors can tell if a baby has jaundice based on a yellowing of the skin and whites of the eyes. Because most neonates are now discharged from the hospital or nursery within 48 hours, many cases of hyperbilirubinemia are detected only after discharge. The symptoms of jaundice include yellowing of the skin and yellowing of the eyes. Once the baby begins to mature and the red blood cell amounts diminish, jaundice will subside with no lasting effects on the baby. Make sure mothers get good support with feeding. Early (days 1-2) - uncommon Make sure that the mothers blood type and antibodies have been checked. Physiologic hyperbilirubinemia occurs in almost all neonates. Most newborn babies turn at least a little bit yellow. After the birth of a baby, it is common for care providers to watch a newborn closely. If it looks yellow instead of pale, there may be jaundice. Maisels MJ, et al. But in some very rare cases it can lead to, or be a sign of, a more serious problem. Bilirubin levels can rise up to 18 mg/dL (308 micromol/L) by 3 to 4 days of life (7 days in Asian infants) and fall thereafter. Bilirubin is a substance created by the normal breakdown of red blood cells. Copyright 2002 by the American Academy of Family Physicians. If your baby has jaundice, your doctor will assess the likelihood of severe jaundice based on a number of factors: How much bilirubin is in the blood Whether your Get the latest in health news delivered to your inbox! Set up a follow-up appointment with the babys doctor. Jaundice is normal in almost all newborns, however, if jaundice appears out of the normal range then steps will be taken to get it back under control. 2007 Sep;120(3):481-488. Jaundice may actually protect babies, because bilirubin is an antioxidant that may help fight infection in newborn infants. Pediatrics. Infant jaundice is a common condition, particularly in babies born before 38 weeks' gestation (preterm babies) and some breast-fed babies. Important associated symptoms include lethargy and poor feeding (suggesting possible kernicterus), which may progress to stupor, hypotonia, or seizures and eventually to hypertonia. Definitive treatment of hyperbilirubinemia involves, This treatment remains the standard of care, most commonly using fluorescent white light. Diagnosis of hyperbilirubinemia is suspected by the infants color and is confirmed by measurement of serum bilirubin. WebThe normal range of bilirubin in newborn babies is approximately 0.3 mg/dl to 1.0 mg/dL within the first 24 hours of birth. Kernicterus Kernicterus Kernicterus is brain damage caused by unconjugated bilirubin deposition in basal ganglia and brain stem nuclei. BONUS! Some of the most common causes of neonatal jaundice include, Pathologic hyperbilirubinemia due to hemolytic disease. Because of the potential seriousness of these complications, intensive phototherapy efforts should be exhausted before exchange transfusion is initiated.26. But, dependent on the levels of bilirubin in the babys blood, and the age of the baby, a more aggressive approach to treatment may be needed. Use a device to check bilirubin level at 24 to 48 hours of life, or sooner if a newborn looks jaundiced or is going home earlier. WebRequired values include the patient's post-menstrual age* and total bilirubin in either US (mg/dl) or SI (mol/L) units. The conjugated bilirubin is excreted in bile into the duodenum. The ideal configuration is four special blue bulbs (F20T12/BB) placed centrally, with two daylight fluorescent tubes on either side. Clinical manifestations of unconjugated hyperbilirubinemia in term and late preterm infants. Jaundice that develops in the first 24 to 48 hours, or that persists > 2 weeks, is most likely pathologic. It can be classified by whether the hyperbilirubinemia is unconjugated, conjugated, or both. Although up to 60 percent of term newborns have clinical jaundice in the first week of life, few have significant underlying disease.1,2 However, hyperbilirubinemia in the newborn period can be associated with severe illnesses such as hemolytic disease, metabolic and endocrine disorders, anatomic abnormalities of the liver, and infections. Prompt treatment may prevent significant lasting damage. 2015;187:335. information submitted for this request. Differences in skin color among races, delays in dermal deposition with rapidly rising bilirubin levels, interobserver variability, and other factors contribute to the difficulty of accurately predicting the total serum bilirubin concentration based on caudal progression alone.18. Physiological jaundice in healthy term babies usually sees bilirubin levels of about 5-6mg/dL on day 4 after birth; they drop over the next week until they reach normal levels Newborns with multiple risk factors might also develop an exaggerated form of physiological jaundice, with bilirubin levels as high as 17mg/dL National Institute of Diabetes and Digestive and Kidney Diseases. However, this is extremely rare. Sign up now and get a FREE copy of theBest Diets for Cognitive Fitness. Exchange transfusions may need to be repeated if bilirubin levels remain high. Other causes of Jaundice include: Learn more about breastfeeding and jaundice. Pediatrics. Enter search terms to find related medical topics, multimedia and more. 2014;89:87. There are four treatment charts for babies born before 35 weeks gestation. Use the lower range of the listed TSB levels for infants at greater risk for bilirubin toxicity: serum albumin levels < 2.5 g/dL; Parents, its important to follow these instructions! Characteristics: increased unconjugated bilirubin level, normal percentage of reticulocytes, Characteristics: increased unconjugated and conjugated bilirubin level, negative Coombs' test, conjugated bilirubin level of >2 mg per dL (34 mol per L) or >20% of total serum bilirubin level, conjugated bilirubin in urine, Characteristics: increased unconjugated bilirubin level, >6 percent reticulocytes, hemoglobin concentration of <13 g per dL (130 g per L). For neonates born at 35 weeks gestation, phototherapy is an option when unconjugated bilirubin is > 12 mg/dL (> 205.2 micromol/L) and may be indicated when unconjugated bilirubin is > 15 mg/dL (257 micromol/L) at 25 to 48 hours, 18 mg/dL (308 micromol/L) at 49 to 72 hours, and 20 mg/dL (342 micromol/L) at > 72 hours ( see Figure: Risk of hyperbilirubinemia in neonates Risk of hyperbilirubinemia in neonates ). No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician. As you feed the baby, it should become colorless. It is not dangerous but tests may need to be done for other problems that are dangerous. the unsubscribe link in the e-mail. Neonatal jaundice affects up to 84% of term newborns 1 and is the most common cause of hospital readmission in the neonatal period. Called kernicterus, this is very, very rare, affecting far less than 1% of infants. When bilirubin levels are extremely high and there is concern for the possibility of brain damage, therapies such as exchange transfusion, where blood is taken out and new blood put back in, are necessary. If the skin looks yellow where you pressed, it's likely your baby has mild jaundice. Common risk factors for hyperbilirubinemia include fetal-maternal blood group incompatibility, prematurity, and a previously affected sibling (Table 1).24 Cephalohematomas, bruising, and trauma from instrumented delivery may increase the risk for serum bilirubin elevation. Kernicterus is brain damage caused by unconjugated bilirubin deposition in basal ganglia and brain stem nuclei, caused by either acute or chronic hyperbilirubinemia. If you are a Mayo Clinic patient, this could This varies with race, those of asian background having a higher incidence. WebKernicterus is a type of brain damage that can result from high levels of bilirubin in a babys blood. The threshold for concern varies by. Finally, there are risks and complications with the procedure, and the success of phototherapy has reduced the frequency of exchange transfusion. With intensive phototherapy, the total serum bilirubin level should decline by 1 to 2 mg per dL (17 to 34 mol per L) within four to six hours.1,5 The bilirubin level may decline more slowly in breastfed infants (rate of 2 to 3 mg per dL per day) than in formula-fed infants.3 Phototherapy usually can be discontinued when the total serum bilirubin level is below 15 mg per dL.1 The average rebound bilirubin level after phototherapy is below 1 mg per dL. (Blue light, wavelength 425 to 475 nm, is most effective for intensive phototherapy.) But call your doctor if you are worried; its always better to be safe than sorry. Check out these best-sellers and special offers on books and newsletters from Mayo Clinic Press. It is not advisable to supplement with water or dextrose because that may disrupt the mothers production of milk. Feeding is an important part of therapy as well, because it helps the body get rid of bilirubin through the blood and urine. [Medline], Copyright document.write(new Date().getFullYear()); American Pregnancy Association Web Design by Edesen, Burping helps everyone expel air that was ingested along with food and drink. Jaundice usually peaks in the first two to five days of life, and lasts about one to two weeks. Decisions about supplementation of a jaundiced newborn should be made on a case-by-case basis. https://www.uptodate.com/contents/search. Jaundice is a condition that can occur in newborns, within 2-3 days of birth. the serum bilirubin level is rising rapidly (more than 8.5 micromol/litre per hour) the serum bilirubin is at a level within 50 micromol/litre below the threshold for The bilirubin is converted to less toxic water-soluble photoisomers that are excreted in the bile and urine without conjugation. Hyperbilirubinemia in the newborn infant 35 weeks' gestation: An update with clarifications. In: Current Diagnosis & Treatment: Pediatrics. For further discussions of cholestasis and disorders of bilirubin excretion in the neonatal period see neonatal cholestasis Neonatal Cholestasis Cholestasis is failure of bilirubin secretion, resulting in conjugated hyperbilirubinemia and jaundice. 1.2.10 In all babies with suspected or obvious jaundice in the first 24 hours of life, measure and record the serum bilirubin level urgently (within 2 hours). 1.2.11 In all babies with suspected or obvious jaundice in the first 24 hours of life, continue to measure the serum bilirubin level every 6 hours until the level is both: If the total serum bilirubin level remains elevated after intensive phototherapy or if the initial bilirubin level is meets defined critical levels based on the infant's age (Table 4),1 preparations should be made for exchange transfusion. Testing for jaundice . Infants without identified risk factors rarely have total serum bilirubin levels above 12 mg per dL (205 mol per L). WebPhysiological 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 Onset pattern similar to physiological type Also, causes poor weight gain Needs close follow-up and weight checks This procedure is repeated until the total desired volume is exchanged. Yellowing of the skin and the whites of the eyes the main sign of infant jaundice usually appears between the second and fourth day after birth. There are now suggested operational thresholds to initiate phototherapy Phototherapy Jaundice is a yellow discoloration of the skin and eyes caused by hyperbilirubinemia (elevated serum bilirubin concentration). Treatment for jaundice includes: Compiled using information from the following sources: 4. This treatment is rarely needed when intensive phototherapy is effective.1,26,27 The procedure removes partially hemolyzed and antibody-coated erythrocytes and replaces them with uncoated donor red blood cells that lack the sensitizing antigen. It's estimated 6 out of every 10 babies develop jaundice, including 8 out of 10 babies born privacy practices. Overall clinical appearance and vital signs are reviewed. It aims to help detect or prevent very high levels of bilirubin, which can be harmful if not treated. The yellow color of newborn jaundice is caused by high levels of a substance called bilirubin in the blood. Learn more about the Merck Manuals and our commitment to Global Medical Knowledge. A practical approach to neonatal jaundice. The physical examination should focus on identifying one of the known causes of pathologic jaundice. Jaundice tends to spread from the face downward as bilirubin levels go up. Its important to keep an eye on your babys jaundice after you go home from the hospital. In this situation, the bilirubin level is invariably below 12 mg per dL. It develops after the first 5 to 7 days of life and peaks at about 2 weeks. However, elevated conjugated bilirubin levels are not directly toxic to brain cells in the neonate.2. Infant jaundice occurs because the baby's blood contains an excess of bilirubin (bil-ih-ROO-bin), a yellow pigment of red blood cells. If a baby is still in the hospital or is readmitted to the hospital, Phototherapy may be administered by placing the baby in a special warmer surrounded by these lights.
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