Why Did My Child Have Jaundice After Birth?

Jaundice (known as hyperbilirubinemia) is quite common in newborns (up to 60% of normal newborns) and is even more common in premature births.

Bilirubin is produced by the normal breakdown of red blood cells. This unconjugated bilirubin then gets transported to the liver to get processed (conjugated) for excretion. Certain physiologic factors in a newborn may hinder that process which can then lead to higher than normal levels of circulating unconjugated bilirubin. Unconjugated bilirubin can be neurotoxic, causing kernicterus, at certain levels. Kernicterus is a rare, but severe, disorder due to excess bilirubin deposition into brain cells. Symptoms include lethargy, fever, vomiting and severe muscle spasms.

Bilirubin levels in normal term infants increase from birth, reaching peak levels of 5 to 7 mg/dl around days 3 to 5 of life and then decline by days 7 to 10. Breast fed infants typically have higher levels of bilirubin. All infants should be assessed for the development of jaundice. Any child that is exhibiting signs of jaundice should have a bilirubin level drawn and carefully tracked over time. Jaundice is usually visible when bilirubin levels are 5 to 7 mg/dl, causing a yellow tinting of the skin, appearing first on the face and progressing to the trunk and extremities. It may also produce clay colored stools, dark urine and yellow tinting of the conjunctiva (yellow eyes.)

Current guidelines require serum measurement of bilirubin in any child who develops jaundice in the first 24 hours of life. Before discharge from the hospital, all infants need to be assessed for their risk of developing severe jaundice. This is best accomplished by measuring the bilirubin levels and plotting the values on an hour specific nomogram that can identify risk levels.

The treatment for most cases is phototherapy and works well for the majority of cases of hyperbilirubinemia. In more severe cases, exchange transfusion may be used.