Bilirubin is a yellowish substance that is a byproduct when red blood cells are broken down. Red blood cells are always being broken down and replaced by the body. Bilirubin is normally broken down by the liver. Jaundice occurs when bilirubin builds up faster than the liver can break it down and eliminate it from the body. Newborns are transitioning from fetal red blood cells which have a slightly different form of hemoglobin to normal red blood cells. That process begins right after birth. Their liver is just beginning to function so that makes them more susceptible to jaundice.
How common is jaundice in a newborn?
It is pretty common, 60% to 84% of all newborns born at term will experience some level of jaundice in the first week of life. It even has a name, physiologic jaundice because it is considered normal.
How will I know if my baby has jaundice?
The newborn will start to get a yellowish tinge to the skin. It starts at the top of baby’s head and travels down the body through the torso. The whites of baby’s eyes may start to take on a yellowish tinge. Jaundice usually peaks between 2-5 days after birth, and lasts 1-2 weeks.
What can I do to minimize jaundice?
Bilirubin is eliminated through the digestive system. The single most helpful thing you can do to minimize jaundice is to nurse baby frequently. (Supplementing with formula does not clear out bilirubin any better than breastmilk so formula supplementation is not beneficial.) Light therapy can also be helpful since sunlight breaks down bilirubin. Place baby where natural sunlight will shine with just a diaper on, or completely naked. Do this for 20 minutes 3 times a day. You could also consider having baby under a SAD (seasonal affective disorder) light if there isn’t a lot of sunlight in your home.
When should I be concerned about jaundice?
In between postpartum visits, these are things that would indicate baby may need some help:
- Baby has yellow skin within the first 24 hours after birth
- Baby becomes jaundiced around 3 weeks old
- Baby has yellow skin below the knees
- Baby is lethargic
- Baby is not having wet or soiled diapers. Baby should have wet diapers equal to how many days old they are, and should have some soiled diapers as well.
- Baby has lost more than 10% of birth weight.
Can jaundice be a problem?
Yes, in rare cases, jaundice can be a problem. There is breast milk jaundice, and pathological jaundice, often caused by blood type issues. These types of jaundice are typically recognized by when they appear, or how long they last. Both types are easy to treat if they are recognized and treated early.
Jaundice is pretty common in newborns. It is also pretty easy to address with frequent nursing, and some sunlight exposure or other light therapy. There are some recent studies that indicate jaundice may actually have some benefits as an antioxidant in the first few days after birth, as well as protecting baby from Group B Strep infection. As your midwife, I will help you monitor and address any jaundice your newborn may develop, and advise you when it might be necessary to seek medical help.
Other sources not linked in post:
Thureen, Patti. Deacon, Jane. O’Neill, Patricia. Hernandez, Jacinto. (1999) Assessment and Care of the Well Newborn. W.B. Saunders Company.