OHSU

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
  • Also, causes poor weight gain

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 can't be wakened
  • Not moving or very weak

Call Your Doctor Now (night or day) If

  • Newborn starts to look or act abnormal (e.g., decrease in activity or ability to suck)
  • Feeding poorly (e.g., little interest, poor suck, doesn't finish)
  • 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
  • Jaundice worse than when last seen
  • High-risk baby for severe jaundice (premature baby of 36 weeks or earlier, ABO or Rh blood group problem, sibling needed bili-lights, cephalohematoma, breastfeeding problems)
  • You think your child needs to be seen urgently

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

  • You think your child needs to be seen, but not urgently
  • 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)
  • 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

Bottlefed: If bottle fed, increase the frequency of feedings. Try for an interval of every 2 to 3 hours during the day.

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.

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.

Expected Course: Physiological jaundice peaks on day 4 or 5 and then gradually disappears over 1-2 weeks.

Judging Jaundice:

  • View your baby unclothed in natural light near a window.
  • Press on the skin on the chest with a finger to remove the normal skin tone.
  • Then assess the jaundice yellow color before the pink color returns.
  • Move down the body, doing the same. Try to assess where the jaundice stops (no yellow color).

Call Your Doctor If:

  • Jaundice becomes worse
  • Legs becomes yellow
  • Feeding poorly or weak suck
  • Baby starts to act sick or abnormal
  • Jaundice not gone by day 14

 

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.

 

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Author and Senior Reviewer: Barton D. Schmitt, M.D.
Last Reviewed: 10/11/2011
Last Revised: 10/11/2011
Content Set: Pediatric HouseCalls Symptom Checker
Copyright 1994-2012 Barton D. Schmitt, M.D.

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