Infant jaundice

A healthcare professional will likely diagnose infant jaundice by checking a baby's appearance. However, it's still necessary to measure the level of bilirubin in a baby's blood. The level of bilirubin can show how serious the jaundice is and help decide the course of treatment. Tests to diagnose jaundice and measure bilirubin include:

• A physical exam.
• A laboratory test of a sample of your baby's blood.
• A skin test with a device called a transcutaneous bilirubinometer, which measures the reflection of a special light shone through the skin.

A healthcare professional may order additional tests if there's evidence that your baby's jaundice is caused by an underlying disorder.

Mild infant jaundice often disappears on its own within two or three weeks. For moderate or severe jaundice, a baby may need to stay longer in the newborn nursery or be readmitted to the hospital.

Treatments to lower the level of bilirubin in baby's blood may include:

• Light therapy, also called phototherapy. Your baby may be placed under a special lamp that emits light in the blue-green spectrum. The light changes the shape and structure of bilirubin molecules in such a way that they can be excreted in both the urine and stool. During treatment, your baby will wear only a diaper and protective eye patches. Light therapy may be supplemented with the use of a light-emitting pad or mattress.
• Enhanced nutrition. To prevent weight loss, a healthcare professional may recommend more-frequent feeding or supplementation to ensure that your baby receives enough nutrition.
• Intravenous immunoglobulin (IVIg). Jaundice may be related to blood type differences between mother and baby. This condition results in the baby carrying antibodies from the mother that contribute to the rapid breakdown of the baby's red blood cells. Intravenous transfusion of an immunoglobulin — a blood protein that can reduce levels of antibodies — may decrease jaundice and lessen the need for an exchange transfusion, although results are not conclusive.
• Exchange transfusion. Rarely, when severe jaundice doesn't respond to other treatments, a baby may need an exchange transfusion of blood. This involves repeatedly withdrawing small amounts of blood and replacing it with donor blood. The procedure dilutes the bilirubin and maternal antibodies and is done in a newborn intensive care unit.

When infant jaundice isn't severe, a healthcare professional may recommend changes in feeding habits that can lower levels of bilirubin. Talk to your baby's healthcare professional if you have any questions or concerns about how much or how often your baby is feeding or if you're having trouble breastfeeding. The following steps may lessen jaundice:

• More-frequent feedings. Feeding more frequently will provide your baby with more milk and cause more bowel movements, increasing the amount of bilirubin eliminated in your baby's stool. Infants who are breastfed should have 8 to 12 feedings a day for the first several days of life. Formula-fed infants usually should have 1 to 2 ounces (about 30 to 60 milliliters) of formula every 2 to 3 hours for the first week.
• Supplemental feedings. If your baby is having trouble breastfeeding, is losing weight or is dehydrated, your baby's healthcare professional may suggest giving your baby formula or expressed milk to supplement breastfeeding. Depending on the situation, your baby's health professional may recommend using formula alone for a couple of days and then resuming breastfeeding. Ask your baby's health professional what feeding options are right for your baby.

Bilirubin levels in the blood tend to peak when a baby is between 2 and 5 days old. So it's important for your baby's healthcare professional to examine your baby for jaundice during that time.

When your baby is discharged from the hospital, your baby will be checked for jaundice. If your baby has jaundice, your baby's healthcare professional will assess the likelihood of severe jaundice based on several factors:

• How much bilirubin is in the blood.
• Whether your baby was born prematurely.
• How well your baby is feeding.
• How old your baby is.
• Whether your baby has bruising from delivery.
• Whether an older sibling also had severe jaundice.

Follow-up visit

If risk factors for severe jaundice are present, your doctor may recommend a follow-up visit a day or two after the baby leaves the hospital.

When you arrive for your follow-up appointment, be prepared to answer the following questions.

• How well is your baby feeding?
• Is your baby breastfed or formula-fed?
• How often does your baby feed?
• How often does your baby have a wet diaper?
• How often is there stool in the diaper?
• Does your baby wake up easily for feeding?
• Does your baby seem sick or weak?
• Have you noticed any changes in the color of your baby's skin or eyes?
• If your baby has jaundice, has the yellow color spread to parts of the body other than the face?
• Has your baby's temperature been stable?

You also may prepare questions to ask your baby's care team at a follow-up appointment, including:

• Is the jaundice severe?
• What is the cause of the jaundice?
• What tests does my baby need?
• Does my baby need to begin treatment for jaundice?
• Will my baby need to go back into the hospital?
• When should my baby have a follow-up visit?
• Should I keep feeding my baby the way I am now?
• Can you recommend websites with information about jaundice? Do you have any brochures about jaundice and proper feeding?