The skin of healthy term newborns will turn slightly yellow, or jaundiced, on the third or fourth day of life. This is because of physiological changes that take place at birth. As the infant breathes air, extra red blood cells previously needed to carry oxygen from the placenta are metabolized by the liver. The result is bilirubin, a substance released by the liver into the intestines and bloodstream that is eliminated through the skin and bowel movements. Bilirubin is an antioxidant that has been shown to protect against free radicals in cases of mild jaundice (National Academy of Sciences, 2002).
How Much Jaundice is Normal?
The yellow coloring is seen first on the skin of the face and in the whites of the eyes. It may be quite pronounced, or the skin may look red and blanch to yellow when pressed lightly on the nose, forehead, or cheeks. Jaundice begins at the top of the body and moves downward. Jaundice below the knees is indicative of a total serum bilirubin (TBS) over 15 mg/dL. While prolonged severe hyperbilirubinemia, or kernicterus, can result in brain and liver damage, an infant that feeds well and is alert and active is low risk (Breastfeeding and jaundice, De Steuben, C., Journal of Nurse-Midwifery,1992).
TBS normally peaks at less than 12 mg/dL between three and five days of life and returns to near-normal levels in two weeks. A TBS below 20 mg/dL at this age is considered low risk. A TBS of more than 30 mg/dL is considered high risk (Quest Diagnostics, 2004).
Which Babies are High Risk?
Premature infants, because of the immaturity of their livers, may develop high levels of bilirubin. Those born at less than 35 weeks gestation have the highest risk.
Babies of mothers who have Rh negative blood are at risk of issoimmune hemolytic disease, unless mothers are vaccinated with Rhogam to prevent antibody formation, or unless the mother is not sensitized. Other blood incompatibilities can occur as well, called ABO incompatibilities with an O positive mother and an infant with A or B type, but these seldom require treatment.
Infants who exhibit jaundice in the first 24 hours after birth are at serious risk, and any jaundiced infant that becomes lethargic and does not feed well should be seen by a healthcare professional.
An Accidental Treatment Discovery
In the 1950s aggressive treatment of neonatal jaundice centered around infants receiving blood tranfusions. A nurse working in the nursery noticed that babies placed near the window were less yellow than other babies. Phototherapy became the treatment of choice. Babies are placed under artificial lights, their eyes and genitals covered, and as much skin as possible exposed to a light source.
New developments include blue lights and intermittent light, and a "biliblanket" that glows and can be wrapped around jaundiced babies.
Home Remedies for Jaundice
Breastmilk is known to bind with bilirubin and help eliminate it by infant bowel movements. Early and frequent breastfeeding is the best prevention for neonatal jaundice. The first milk, colostrum, has a beneficial laxative effect. When the first feeding is delayed or nursing takes place only at four-hour or longer intervals, a greater amount of jaundice is likely. Artificial formulas do not have the chemical structure to bind with bilirubin.
Direct and indirect sunlight helps newborn skin eliminate bilirubin. It works to put babies near a window or to sun them naked outside. Do not leave infants unattended; avoid sunburn and extremes of temperatures. Artificial light only works if it is close enough, and the baby's eyes have to be protected; this is best done in a hospital with lights designed for that purpose.
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