Diagnosis

Your doctor will likely diagnose infant jaundice on the basis of your baby's appearance. However, your doctor will need to measure the level of bilirubin in your baby's blood. The level of bilirubin (severity of jaundice) will determine the course of treatment.

Tests to determine jaundice 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

Your doctor may order additional blood tests or urine tests if there's evidence that your baby's jaundice is caused by an underlying disorder.

Treatment

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

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

  • Light therapy (phototherapy). Your baby may be placed under special lighting 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 the urine and stool. The light isn't an ultraviolet light, and a protective plastic shield filters out any ultraviolet light that may be emitted.

    During treatment, your baby will wear only a diaper and protective eye patches. The light therapy may be supplemented with the use of a light-emitting pad or mattress.

  • 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 breakdown of blood cells in the baby. Intravenous transfusion of an immunoglobulin — a blood protein that can reduce levels of antibodies — may decrease jaundice and lessen the need for an exchange blood transfusion.
  • 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, diluting the bilirubin and maternal antibodies, and then transferring blood back into the baby — a procedure that's performed in a newborn intensive care unit.

Lifestyle and home remedies

When infant jaundice isn't severe, your doctor may recommend changes in feeding habits that can lower levels of bilirubin. Talk to your doctor if you have any questions or concerns about how much or how often your baby is feeding or if you're having trouble breast-feeding. 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. Breast-fed infants should have eight 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 two to three hours for the first week.
  • Supplemental feedings. If your baby is having trouble breast-feeding, is losing weight or is dehydrated, your doctor may suggest giving your baby formula or expressed milk to supplement breast-feeding. In some cases, your doctor may recommend using formula alone for a couple of days and then resuming breast-feeding. Ask your doctor what feeding options are right for your baby.

Preparing for your appointment

Bilirubin levels in the blood tend to peak when your baby is between three and seven days old. So it's important for your doctor to examine your baby for jaundice during that time.

When your baby is discharged from the hospital, your doctor or nurse will look for jaundice. If your baby has jaundice, your doctor will assess the likelihood of the jaundice being severe based on a number of factors:

  • How much bilirubin is in the blood
  • Whether your baby was born prematurely
  • How well he or she 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

Based on these factors, your doctor may recommend an earlier follow-up visit.

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

  • How well is your baby feeding?
  • Is your baby breast-fed or formula-fed?
  • How often is he or she feeding?
  • How often does your baby have a wet diaper?
  • How often is there stool in the diaper?
  • Does he or she 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 the baby's temperature been stable?

You may also prepare questions to ask your doctor at your follow-up appointment, including:

  • Is the jaundice severe?
  • What tests will my baby need?
  • Do we need to begin treatment for jaundice?
  • Will I need to readmit my baby to the hospital?
  • When should I schedule a follow-up visit?
  • Do you have any brochures about jaundice and proper feeding?
  • May I continue current feedings?

Don't hesitate to ask other questions.

April 03, 2014
References
  1. Wong RJ, et al. Clinical manifestations of unconjugated hyperbilirubinemia in term and late preterm infants. http://www.uptodate.com/home. Accessed Nov. 7, 2013.
  2. Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation. American Academy of Pediatrics Policy. http://pediatrics.aappublications.org/content/114/1/297.full.html. Accessed Nov. 7, 2013.
  3. Hay WW, et al. Current Diagnosis & Treatment: Pediatrics. 21st ed. New York, N.Y.: The McGraw-Hill Companies; 2012. http://www.accessmedicine.com /resourceTOC.aspx?resourceID=14. Accessed Nov. 7, 2013.
  4. Wong RJ, et al. Evaluation of unconjugated hyperbilirubinemia in term and late preterm infants. http://www.uptodate.com/home. Accessed Nov. 7, 2013.