DEAR DOCTORS: When my nephew was born last year, he had something the doctors called neonatal jaundice. It went away after a few weeks, and he seemed fine. Then the same thing happened when I had my daughter. Why do babies get jaundice? Is it dangerous for them?
DEAR READER: Neonatal jaundice is a common condition in which a baby's skin and eyes take on a yellowish tint within the first few days of birth. It occurs in up to two-thirds of all healthy newborns, and in the majority of cases, it does not indicate a health problem.
Let's start with the name of the condition itself. The word neonatal refers to the first four weeks of an infant's life. The term jaundice comes from the word jaune, which means yellow in French.
The reason that jaundice causes a change to skin colour is due to a buildup in the blood of a compound known as bilirubin, which is yellowish in colour. Bilirubin is a natural byproduct of the breakdown of ageing red blood cells. As blood circulates through the liver, the bilirubin that it contains is filtered out. The liver then breaks down the captured bilirubin into a form that the body can get rid of. These final compounds are sent to the small intestine where, after being further dismantled by certain bacteria, they exit the body via the stool.
While the baby is still in the womb, bilirubin is removed from the blood via the placenta. After birth, however, that job falls to the baby's own organs. A newborn's liver can take a bit of time to begin to function efficiently. At the same time, newborns have greater numbers of red cells than adults or older children, and the cells have a shorter life cycle. These two factors can easily lead to a buildup of bilirubin in the infant's blood. It can take a bit of time, sometimes up to two weeks, for the baby's liver to become effective at filtering bilirubin from the blood.
The symptoms of neonatal jaundice begin in the face, then move to the chest, belly and legs. In babies with darker skin, this change in colour is sometimes easier to discern on the palms of the hands and soles of the feet.
In the majority of babies, neonatal jaundice will resolve on its own, usually after a few days to two weeks. It's just a matter of waiting for the infant's liver to catch up to the amount of bilirubin that needs to be removed.
In very rare cases, the condition can signal a more serious problem. When bilirubin levels become high, babies can experience changes to behaviour as well as to appearance. Behaviour changes can include becoming fussy, poor feeding, developing floppy limbs and being unusually sleepy. If a problem is suspected, a blood test may be used to help with diagnosis.
Treatment can vary, from addressing potential dehydration with increased liquid intake to a range of medical interventions. All of this makes it important to have a healthcare provider monitor the course of neonatal jaundice. Universal Features Syndicate
Dr Eve Glazier is an internist and associate professor of medicine at UCLA Health. Dr Elizabeth Ko is an internist and assistant professor of medicine at UCLA Health.
