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)
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.
HOME CARE 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.
Lucile Packard Children's Hospital is located in Palo Alto, adjacent to Stanford University Hospital, approximately 20 miles north of San Jose, CA and 40 miles south of San Francisco.
