Jaundiced Newborn

Symptom Definition

• The skin and whites of the eyes (sclera) are 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

Rh and ABO blood group incompatibility

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

Breast-milk jaundice (1% of newborns)

• Due to substance in breastmilk which blocks destruction of bilirubin
• Can reach harmful levels
• Onset 4 to 7 days of age
• Lasts 3 to 10 weeks
• Not harmful

Call Your Doctor Now (night or day) If

• Newborn starts to look or act sick (e.g. decrease in activity, ability to suck)
• Signs of dehydration (very dry mouth, sunken soft spot, no urine in 8 hours)
• Fever > 100.4°F (38.0°C) rectally
• Low temperature < 96.8°F (36.0°C) rectally
• Jaundice began during the first 24 hours of life

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

• You think your child needs to be seen
• You are concerned your baby is not getting enough breastmilk.
• Good-sized yellow, seedy BMs are < 3 per day (EXCEPTION: breastfed and before 5 days of life)
• Wet diapers are < 6 per day (EXCEPTION: 3 wet diapers per day can be normal before 5 days of life if breastfed)
• Skin looks deep yellow or orange

Call Your Doctor During Weekday Office Hours If

• You have other questions or concerns
• Color gets deeper after 7 days old
• Jaundice is not gone after 14 days old
• Jaundice began after 7 days of age

Parent Care at Home If

• Normal 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 the baby every 1½ to 2½ hours during the day. Don’t let the baby sleep more than 4 hours at night without a feeding.
3. Increase BMs: If your baby is 5 days or older AND has < 3 BMs/day, carefully insert a lubricated thermometer 1/2 inch into the anus and gently move it from side to side a few times to stimulate a BM. (Reason: increased BMs carry more bilirubin out of the body)
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 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 or develops any of the “Call Your Doctor” symptoms