Why is my baby yellow? An introduction to newborn jaundice.
Have you ever looked at a newborn and wondered why they looked a little yellow? It's likely due to a transient condition called jaundice. Not to worry, for most babies it resolves on its own. If the jaundice requires treatment, it is treated in the hospital or at home for a brief period of time without any harm to your baby (when treated promptly and properly).
But what the heck is jaundice? And why do babies get it? Most people think of jaundice as being something that people with liver disease get. The pathology is quite different for newborns since their liver is brand spanking new, which is part of the cause.
Before your baby is born, when he or she is still a fetus, they produce large amounts of red blood cells, which are responsible for carrying oxygen throughout their system. Hemoglobin is a component of the red blood cells that is responsible for transporting oxygen. How does a fetus get oxygen? It travels from your bloodstream via the placenta. Pretty amazing. This is how they get oxygen while in utero. This means that when your baby is born they have both fetal and adult hemoglobin! The fetal hemoglobin takes care of oxygen needs in utero but once your baby is born ONLY the adult hemoglobin is needed. Because of this, their body must get rid of the extra fetal hemoglobin that is no longer needed. Their body breaks it down and separates the "heme" + "globin". It reuses the globin and the body processes the heme and one of the bi-products is called bilirubin. The liver is able to process some of it but keep in mind that since your baby is brand new... their liver is too! Some of the bilirubin is handed over to the intestine and your baby then poops it out. A tiny amount is excreted in urine (but not a whole lot in the grand scheme of things). Some of it remains in their bloodstream waiting to be processed next when the body is able to. Most of the time this process occurs naturally & gradually over a few days. Treatment comes into play when there is an excess beyond what has just been described.
Treatment options range anywhere from breastfeeding your baby more frequently to phototherapy (light therapy). When the baby is breastfed more frequently it helps to decrease bilirubin levels. How? What goes in must come out, right? The more your baby poops, the more bilirubin is excreted. Plain and simple. A bonus is that the colostrum (first milk produced) has a laxative-like effect to it and will help the baby poop more! Also, the more the baby breastfeeds there is increased stimulation to the nipple, areola and breast tissue, telling your body to increase breastmilk production. Using a breast pump can help with the expression of breastmilk and stimulation to increase breastmilk supply. Depending upon test results after frequent breastfeeding has been implemented, some physicians may suggest supplementation with donor or formula. You may have seen pictures of babies receiving phototherapy... it looks like they are in a little tanning bed. The light helps to breakdown bilirubin. Some hospitals work with medical device companies that are able to provide a bili-blanket for use at home. The baby is wrapped in a blanket that lights up.
So... why the yellow skin color? Bilirubin has a yellow pigment to it. As the levels of jaundice go up you will notice the yellow color moving down the body from the head (and eyes) to the feet. It resolves in the opposite manner, the face being the last to return to normal skin tone.
Every baby that is born under the care of a licensed medical provider will be screened for jaundice after birth. The test is quite simple. A transcutaneous (fancy word for "on top of the skin") bilimeter will be placed on your baby's forehead a few times until a reading is received. Whether your baby needs treatment or further testing is dependent upon the results. The most accurate reading is via blood so if your baby's pediatrician orders a blood test after testing with a bilimeter it is because they want the most reliable reading.
One thing to be aware of is that jaundice can make babies sleepy and for some babies they become less interested in feeding. In this circumstance it is important to use manual expression and/or a breast pump to express breastmilk and to provide stimulation to the breast tissue during this period. Stimulation to the breast signals the hormones of breastmilk production and letdown. As the breastmilk increases in volume it then becomes important to remove milk in order for the body to make milk! If your baby is sleepy and not interested in latching, try feeding the expressed breastmilk to your baby via your (clean) finger, spoon, syringe or medicine cup.
I hope this provides a bit of clarity about jaundice! If you have any concerns about your baby's jaundice symptoms or think that your baby may be jaundiced please contact your baby's pediatrician right away.
Lisa Grossman, RN, BSN, PHN, OCN, CLC, CLEC
Owner, South Bay Baby Care Nursing Services, Inc.
South Bay Baby Care, INC
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(Disclaimer: This is not a comprehensive summary of conditions that may cause neonatal jaundice. Other factors may contribute to increased serum bilirubin levels such as ABO blood incompatibility, disease(s), autoimmune conditions, metabolic deficiencies and other pathology. Please speak with a licensed medical provider if you would like more information about jaundice.)
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