Understanding and Reducing the Risk of Newborn Jaundice

What is Newborn Jaundice?

Jaundice is caused by a buildup of a yellow substance called bilirubin in the blood. Before birth, a mother’s liver removes bilirubin for the baby. After birth, the baby’s own liver, which is still immature, must take over this job. In many newborns, the liver isn’t quite efficient enough at first, leading to a temporary buildup of bilirubin.

Most jaundice is “physiological jaundice,” meaning it is a normal process. It typically appears on the second or third day after birth and resolves on its own within one to two weeks.

How to Help Reduce the Risk and Severity

While it is not always possible to completely prevent jaundice, the following strategies are highly effective in managing bilirubin levels and preventing them from rising to dangerous levels.

1. Frequent and Effective Feeding (The Most Crucial Step)

The primary way a baby excretes bilirubin is through their stool (meconium). Feeding helps push the bilirubin out of the body.

• Feed Early and Often: Aim for 8-12 feedings in a 24-hour period. In the first few days, waking your baby for feeds is often necessary.
• Watch for Hunger Cues: Look for signs like lip-smacking, rooting, and putting hands to mouth. Don’t wait for crying, which is a late sign of hunger.
• Ensure Good Latch and Transfer: Whether breastfeeding or bottle-feeding, make sure your baby is effectively swallowing milk. For breastfeeding mothers, consulting a lactation consultant can be invaluable for ensuring the baby is getting enough milk.
• Monitor Output:
  • Wet Diapers: Expect 1-2 wet diapers on day one, increasing to 6-8 wet diapers by day five.
  • Stool Diapers: The stool should transition from dark, tarry meconium to greenish-yellow, and then to seedy, yellow stools by day five. Frequent stools are a good sign that bilirubin is being cleared.

2. Understanding the Different Needs for Breastfed Babies

Breastfeeding jaundice is common and usually manageable.

• “Not Enough Milk” Jaundice: This can occur if the baby is not getting enough breast milk, often due to difficulties with latching or milk supply. The solution is not to stop breastfeeding but to increase milk supply and transfer with more frequent feeding and professional support.
• “Breast Milk” Jaundice: This appears after the first week in some healthy, thriving breastfed babies. It is thought to be caused by a substance in the mother’s milk that can increase bilirubin reabsorption. It usually resolves slowly on its own. Do not stop breastfeeding. Your pediatrician will monitor the bilirubin levels to ensure they remain safe.

3. Be Observant: Know the Signs

Early detection is key to simple and effective treatment.

• Check the Skin and Eyes: In natural light, gently press on your baby’s forehead or nose. If the skin appears yellow where you pressed, it may be jaundice.
• Watch for Progression: Jaundice typically starts on the face and moves down the chest, abdomen, and finally to the legs.
• Watch for Warning Signs: Contact your doctor immediately if your baby:
  • Becomes very yellow or orange.
  • Is difficult to wake or is unusually sleepy.
  • Is not feeding well.
  • Has a high-pitched cry.
  • Arches their body backwards.