The term jaundice comes from the French word jaune, meaning yellow, and refers to a yellow discoloration of the skin and the whites of the eyes (sclera) from the deposition of the pigment called bilirubin. Bilirubin largely comes from the breakdown of hemoglobin, the protein that carries oxygen in the red blood cells. With neonatal jaundice, increase in bilirubin load resulting in hyperbilirubinemia is due to either/both an increase in bilirubin production or a decrease in bilirubin clearance. Almost all babies develop a serum bilirubin >1 mg/dl, which is the upper limit of normal for an adult. For most babies, this early rise in bilirubin is considered normal, transient and physiologic.
Bilirubin exists in the unconjugated (indirect) form, its state prior to metabolism in the liver, and the conjugated (direct) form, its state following transformation in the liver and excretion into the bile and intestines. Most neonatal jaundice is normal, unconjugated, and related to natural breakdown of fetal hemoglobin, immaturity of the newborn liver to efficiently metabolize bilirubin, low intake/dehydration from breast feeding, and reabsorption of bilirubin from the intestinal tract during sluggish elimination of stool.
It is normal for most babies to have some degree of jaundice following their birth, which often peaks around 10-12 by day 4-5, though may linger for up to two weeks of age or longer (especially in breast fed babies). All babies have their bilirubin checked, measuring over the skin (transcutaneously) or by a blood test, prior to leaving the hospital: the gestational age of the newborn, the age of the baby at the time of the test, and the height of the bilirubin all determine whether the baby is at low, medium or high risk for developing significant jaundice. Your pediatrician or nurse practitioner will continue to carefully monitor your baby for jaundice once you leave the hospital. We can clinically estimate the level of the jaundice: jaundice on the face roughly correlates to a bilirubin level of 4-8, upper trunk 5-12, lower trunk 8-16, and soles of the feet >16. For babies with notable jaundice, we will repeat bilirubin levels with a blood test in the office (same day results from Quest) to monitor the height of the total/direct bilirubin. Why does it matter? Because severely elevated total bilirubin >25 mg/dl allows bilirubin to cross into the brain, which may cause brain damage (bilirubin-induced neurologic dysfunction or BIND, formerly known as kernicterus), and elevated direct bilirubin above 2mg/dl or 20% of the total may indicate a problem with the conjugation or excretion of bilirubin anyplace within the liver/biliary system (cholestasis), which must be identified/treated quickly to minimize liver damage.
Again, most jaundice in newborns is benign and transient. Risk factors for more severe hyperbilirubinemia include prematurity; maternal diabetes; race (Asians and Native Americans); male sex; trisomy 21 (Down Syndrome); blood in the scalp following vaginal delivery (cephalohematoma); hemolysis (abnormal breakdown of blood cells, e.g., one such cause is if the baby and mom have different blood types - ABO and/or Rh - and antibodies against the baby’s blood type cross the placenta and attack red blood cells in the baby); oxytocin induction; breast feeding; delayed passage of meconium; gene mutations; and a history of siblings who had neonatal jaundice.
So what should you expect if your baby has newborn jaundice? We will take a detailed history of the pregnancy, labor and delivery, feeding and elimination patterns, review blood group incompatibilities, and obtain your family history, all for identifying risk factors for elevated bilirubin. We will perform a complete physical examination of the baby, noting the color of the skin/eyes, the size and feel of the liver and spleen, and the presence of rash or other signs of congenital infection. We will monitor your baby’s bilirubin, both clinically and with same-day blood testing (total and direct bilirubin) sent to Quest from the office. Most of the time that is sufficient, and the jaundice resolves. Occasionally babies with unconjugated hyperbilirubinemia will be treated with blue-light phototherapy in the hospital to aide in the reduction of the serum bilirubin, and that therapy may be extended with the use of a “bili blanket” upon discharge home. Putting your baby near a window with indirect light is also helpful, as is increasing the volume or frequency of feeding to improve hydration, stimulate the production of stool, and decrease reabsorption of bilirubin from the gut back to the bloodstream.
If your newborn’s examination is abnormal, if the jaundice continues past two weeks, or if there is cholestasis, we will request additional labwork to assess hemolysis, liver function, metabolic disorders, or the presence of infection. We may order an ultrasound of the liver and gall bladder to look at the structures, assess the presence/patency of bile ducts, and determine any other mechanical cause of cholestasis. Other more complex radiology studies may be necessary. Rarely, liver biopsy may be required. For newborns with persistent or pathological jaundice, we will enlist the help of a pediatric gastroenterologist to help manage the evaluation and your baby’s ongoing care.
Remember that newborn jaundice is generally normal, transient, and benign. If you have questions or concerns, we are here for you. Reach out on the portal or schedule an appointment to come see us in the office if you are wondering about how to best care for your newborn with jaundice.
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Sundays & Holidays
Morning Urgent Hours Available For Coral Springs, Only After 8 am
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1951 SW 172nd Avenue Ste 200
Miramar, FL 33029
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Monday & Friday
8 am - 12pm
Saturday
8 am - 12pm
Sundays & Holidays
Morning Urgent Hours Available For Coral Springs, Only After 8 am
PLANTATION
8430 W. Broward Blvd Ste300
Plantation, FL 33324
(954)-473-8588 (fax)
Mon- Fri. 8 am - 5 pm (Closed for Lunch 12pm-1:30pm)
Saturday 8 am - 12 pm
Sunday Morning Urgent Hours Available For Coral Springs, Only After 8 am
TAMARAC
7489 North University Drive
Tamarac, FL 33321
(954)-722-4888 (fax)
Mon- Fri. 8 am - 5 pm ( Closed for Lunch 12pm-1:30pm)
Saturday 8 am - 12pm
Sunday Morning Urgent Hours Available For Coral Springs, Only after 8 am
CORAL SPRINGS
5697 Coral Ridge Dr.
Coral Springs, FL 33076
(954) 510-4800 (fax)
Mon- Fri. 8 am - 5 pm (Closed for Lunch 12pm-1:30pm)
Saturday 8 am - 12pm
Sunday Morning Urgent Hours Available For Coral Springs, Only After 8 am
Miramar
1951 SW 172nd Avenue Ste 200
Miramar, FL 33029
(954) 722-4888 (fax)
Mon & Fri. 8 am - 12pm
Saturday 8 am - 12pm
Sunday Morning Urgent Hours Available For Coral Springs, Only After 8 am
PLANTATION
8430 West Broward Blvd Ste 300
Plantation, FL 33324
(954)-473-8588 (fax)
Monday- Friday
8 am - 5 pm
(Closed for Lunch 12pm-1:30pm)
Saturday
8 am - 12 pm
Sunday & Holidays
Morning Urgent Hours Available For Coral Springs, Only After 8 am
TAMARAC
7489 North University Drive
Tamarac, FL 33321
(954)-722-4888 (fax)
Monday - Friday
8 am - 5 pm
(Closed for Lunch 12pm-1:30pm)
Saturday
8 am - 12pm
Sundays & Holidays
Morning Urgent Hours Available For Coral Springs, Only After 8 am
CORAL SPRINGS
5697 Coral Ridge Dr.
Coral Springs, FL 33076
(954) 510-4800 (fax)
Monday- Friday
8 am - 5 pm
(Closed for Lunch 12pm-1:30pm)
Saturday
8 am - 12pm
Sundays & Holidays
Morning Urgent Hours Available For Coral Springs, Only After 8 am
Miramar
1951 SW 172nd Avenue Ste 200
Miramar, FL 33029
(954) 722-4888 (fax)
Monday & Friday
8 am - 12pm
Saturday
8 am - 12pm
Sundays & Holidays
Morning Urgent Hours Available For Coral Springs, Only After 8 am
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