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Jaundiced Newborn

 

DEFINITION

  • The skin and whites of the eyes have turned 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
Breastfeeding jaundice (5 to 10% of newborns)

  • Due to inadequate intake of breastmilk
  • Pattern similar to physiological type
Breastmilk 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
Rh and ABO blood group incompatibility

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

WHEN TO CALL YOUR DOCTOR

Call 911 Now (your child may need an ambulance) If

  • 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 or ability to suck)
  • Signs of dehydration (no urine in 8 hours, very dry mouth, sunken soft spot)
  • Fever above 100.4° F (38.0° C) rectally (Caution: Do NOT give your baby any fever medicine before being seen)
  • Low temperature below 96.8° F (36.0° C) rectally that doesn't respond to warming
  • Jaundice began during the first 24 hours of life
  • Skin looks deep yellow or orange
  • Jaundice has reached the legs
  • You think your child needs to be seen

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

  • You are concerned your baby is not getting enough breastmilk
  • Good-sized yellow, seedy stools are less than 3 per day (EXCEPTION: breastfed and before 5 days of life)
  • Day 2-4 of life and no stool in over 24 hours and breastfed
  • Wet diapers are less than 6 per day (EXCEPTION: 3 wet diapers/day can be normal before 5 days of life if breastfed)
  • Discharged before 48 hours of life AND 4 or more days old AND hasn't been examined since discharge (Reason: AAP recommends re-check)
  • High-risk baby for severe jaundice (premature baby of 35 weeks or earlier, ABO or Rh blood group problem, sibling needed bili-lights)
  • You have other questions or concerns

Call Your Doctor During Weekday Office Hours If

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

Parent Care at Home If

  • Mild jaundice of newborn and you don't think your child needs to be seen

 

HOME CARE ADVICE FOR MILD JAUNDICE

  1. Bottlefed: If bottle fed, 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 your baby every 1½ to 2½ hours during the day. Don't let your 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 (12 mm) 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 on the chest 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

And remember, contact your doctor if your child 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.

 
Author and Senior Reviewer: Barton D. Schmitt, M.D.
Last Reviewed: 3/15/2008
Last Revised: 6/24/2008
Content Set: Pediatric HouseCalls Online
Copyright 1994-2008 Barton D. Schmitt, M.D.
 
 

Lucile Packard Foundation for Children’s Health | Stanford University School of Medicine | Stanford Hospital & Clinics