JAUNDICED NEWBORN

Definition

  • The skin and whites of the eyes are yellow.

Types 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  

Rh and ABO blood group incompatibility

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

Breastfeeding jaundice
(5 to 10% of newborns)

  • Due to inadequate intake of breastmilk
  • Pattern similar to physiological type

Breast-milk jaundice (1% of newborns)

  • Due to substance in breastmilk which
    blocks destruction of bilirubin
  • Onset 4 to 7 days of age
  • Lasts 3 to 10 weeks
  • Not harmful

WHEN TO CALL YOUR DOCTOR FOR JAUNDICED NEWBORN

Call 911 Now (your child may need an ambulance)

  • Unresponsive or difficult to awaken
  • Not moving or very weak

Call Your Doctor Now (night or day) If

  • Newborn starts to look or act sick (e.g., decrease in activity, ability to suck).
  • Signs of dehydration (very dry mouth, sunken soft spot, no urine in 8 hours).
  • Fever above 100.4°F (38.0°C) rectally.  
  • Low temperature below 96.8° F (36.0°C) rectally.  
  • Jaundice began during the first 24 hours of life.

Call Your Doctor Within 24 Hours (between 9am and 4pm) If

  • You think your child needs to be seen.
  • You are concerned your baby is not getting enough breastmilk.
  • Good-sized yellow, seedy stools are less than 3 per day.  (EXCEPTION: not valid until breastmilk comes in on day 4 or 5)
  • Wet diapers are less than 6 per day.  (EXCEPTION: 2 wet diapers/day can be normal until milk comes in on day 4 or 5)
  • Skin looks deep yellow or orange.
  • Discharged before 48 hours AND 4 or more days old AND hasn't been examined since discharge (Reason: AAP recommends re-check)
  • Blood type problem (ABO, Rh) present

Call Your Doctor During Weekday Office Hours If

  • You have other questions or concerns.
  • Color gets deeper after 7 days old.  
  • Jaundice is not gone after 14 days old.
  • Jaundice began or reappeared after 7 days of age.
  • Stools are white, pale yellow or gray.

Parent Care at Home If

  • Normal jaundice of newborn and you don't think your child needs to be seen.
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HOME ADVICE FOR MILD JAUNDICE

  1. Bottlefed:  If bottlefed, increase the frequency of feedings.  Try for an interval of every 2 to 3 hours during the day.
  2. Breastfed:  If breastfed, increase the frequency of feedings.  Nurse the baby every 1½ to 2½ hours during the day.  Don't let the baby sleep more than 4 hours at night without a feeding.
  3. Increase stools:  If your baby is 5 days or older AND has less than 3 stools/day, carefully insert a lubricated thermometer ½ inch into the anus and gently move it from side to side a few times to stimulate a stool (reason: increased stools carry more bilirubin out of the body). Do this once or twice per day until jaundice improves or stool frequency becomes normal.
  4. Expected Course:  Physiological jaundice peaks on day 4 or 5 and then gradually disappears over 1-2 weeks.
  5. Judging Jaundice:  View your baby unclothed in natural light near a window.  Press on the yellow skin with a finger to remove the normal skin tone.  Then assess the jaundice color before the pink color returns.
  6. Call Your Doctor If:
    • Jaundice not gone by day 14.
    • Your baby is not getting enough milk. (needs a weight check).
    • Your baby starts to act sick.
    • Your child becomes worse or develops any of the "Call Your Doctor" symptoms.
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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.

Pediatric HouseCalls Online. Copyright © 2000-2004 Barton Schmitt, M.D. FAAP

Reviewed 8/2004

Revised 8/2004

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