Originally published by CBSHealthwatch.com November 2000.
Kimberly Nelson Medical Writer
If you notice a yellow tint to your newborn's skin, don't panic. The coloring, known as jaundice, is found in more than half of all newborns. But it is critical that a child with this condition gets tested and monitored because complications stemming from neonatal jaundice are on the rise.
Both new mothers and doctors should be aware of the signs, say Jacqueline Grupp-Phelan, MD, MPH, Children's Hospital Medical Center in Cincinnati.
"Jaundice looks like a well-tanned infant," explains Dr. Grupp-Phelan. "The whites of the eyes appear somewhat yellow and the baby appears bronze tan sometimes down to their legs."
"Neonatal Jaundice is a condition that is a result of accumulation of a pigment called bilirubin," explains Jeffrey Maisels, MD, FAAP, Chairman, Department of Pediatrics, William Beaumont Hospital. "Everyone has it in their blood, but babies have a higher concentration of it.
"In the majority of babies, the condition is harmless and doesn't cause any problems," Dr. Maisels says. "If the bilirubin gets too high it can be toxic to the central nervous system. It can cause brain damage and affect hearing." But treatments are fairly simple and noninvasive, he says.
Bilirubin is created by the breakdown of red blood cells. In adults bilirubin is broken down in the liver. In the womb, babies pass their bilirubin through the placenta for their mother to handle. Newborns can't handle the bilirubin as well because their livers aren't fully functioning yet.
"Two out of three normal infants show some form of jaundice. Bilirubin levels peak on the fourth or fifth day and then decline and return to normal in approximately 2 weeks," adds Dr. Maisels. The first few days are critical to detecting and treating bilirubin levels.
Watch For It
Recently, complications from too much bilirubin--hyperbilirubinemia--have begun to show up again. The result is a rare condition call kernicterus.
"There has been an increase of case reports of the most severe complications called kernicterus and these case reports are very concerning," says Dr. Grupp-Phelan. Changes to the healthcare system have resulted in babies being discharged earlier. This increases the risk of the jaundice going unnoticed and the bilirubin levels getting too high.
"Very few pediatricians have ever seen a case of kernicterus, so the feeling was that it had gone away," says Dr. Maisels.
"What happened, is that when babies stayed in the hospital for 3-4 days the doctors could notice the jaundice and measure bilirubin levels and then treat the child," explains Dr. Maisels. "Now the baby leaves the hospital in 48 hours and that is when the baby is starting to show jaundice." The jaundiced look may be subtle and go unnoticed by the mother.
"Early discharge combined with very comprehensive and early physician follow-up is probably a safe practice," adds Dr. Grupp-Phelan
True, says Dr. Maisels, who notes the American Academy of Pediatricians (AAP) recommends follow up by a nurse or physician for babies discharged within the first 2 or 3 days of being born. A heightened awareness on the part of the physicians and families will help prevent complications, he says.