Jaundice is the term given to a yellow discoloration of the skin and eye that occurs in infants, children and adults. This coloration is caused by an excess amount of bilirubin (billy-roo-bin) in the skin and blood. Bilirubin is a yellow pigment that occurs naturally in everyone’s body. It is created and released when red blood cells have broken down (living an average of 120 days). Most babies have an excess of red blood cells at birth and it is natural for the body to break down these cells. As the cells are destroyed more bilirubin is created and unless it is excreted, the level builds up and the skin assumes a yellow color. In older children and adults this is easily passed through the liver, processed and excreted from the body. In newborns however, organs such as the liver are not fully developed and processes are still active that result in an increased amount of bilirubin being recirculated to the liver.

Occasionally there are other factors which will cause the baby’s red blood cells to break down more rapidly. The two most common conditions are called ABO incompatibility and Rh incompatibility. If the jaundice is caused by either of these conditions, we will discuss it with you in more detail. Jaundice usually appears on the second or third day of life. Because some babies go home within 48 hours of birth, it is possible the jaundice will not appear prior to discharge from the hospital. Therefore, we suggest that they be seen two or three days from discharge. If your baby appears to be very yellow or orange prior to or after their first office visit, call us.

The most common treatment for jaundice is phototherapy or a “bili blanket.” Phototherapy consists of a series of special fluorescent lights placed over the baby’s crib or bassinette. The light results in a chemical reaction in the skin, which breaks down the bilirubin (photodecomposition). The broken down bilirubin is excreted by the liver and kidneys. The light is used for several days depending on the results of laboratory tests. During sessions under the light the baby will wear a mask which covers the eyes to prevent eye damage (bili blankets do not require eye protection). You will need to change the baby’s position frequently to assure all areas are exposed to the light as much as possible.

Contrary to what you may have heard, do not place your infant in sunlight in an attempt to bring down the bilirubin level. Direct sunlight can quickly cause sunburn; sunlight filtered through glass still contains a considerable amount of infrared and may seriously over heat your baby. There is no safe and effective method of using sunlight in this manner. However, feeding breast milk or formula is highly beneficial and recommended. Unfortunately, feeding water or glucose water is not helpful and there is evidence to suggest this can increase bilirubin levels.

The phototherapy lights are well tolerated. Occasionally, a temporary skin rash can develop, or rarely a greenish cast to the skin. Stools often become more frequent during therapy as the bilirubin is excreted and can be green in color.

In some instances, readmission to the hospital is necessary for more effective treatment of jaundice. Very rarely, treatments in addition to phototherapy are indicated. If this is warranted, we will discuss this with you in detail.

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