Diagnosis

Your doctor will likely diagnose infant jaundice on the basis of your baby's appearance. However, it's still necessary 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 detect 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

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 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.
  • 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.
  • 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, thereby diluting the bilirubin and maternal antibodies — 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 severe jaundice 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

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

  • Is the jaundice severe?
  • What tests will my baby need?
  • Does my baby need to begin treatment for jaundice?
  • Will I need to readmit my baby to the hospital?
  • Is the jaundice severe?
  • 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?
  • Do you have any brochures about jaundice and proper feeding?
Aug. 30, 2018
References
  1. Wong RJ, et al. Clinical manifestations of unconjugated hyperbilirubinemia in term and late preterm infants. https://www.uptodate.com/contents/search. Accessed April 2, 2018.
  2. Maisels MJ, et al. Hyperbilirubinemia in the newborn infant ">>35 weeks' gestation: An update with clarifications. Pediatrics. 2009;124:1193.
  3. American Academy of Pediatrics Subcommittee on Hyperbilirubinemia. Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation. Pediatrics. 2004;114:297.
  4. Subcommittee on Hyperbilirubinemia. Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation. American Academy of Pediatrics. http://pediatrics.aappublications.org/content/114/1/297. Accessed April 2, 2018.
  5. Hay WW, et al., eds. The newborn infant. In: Current Diagnosis & Treatment: Pediatrics. 23rd ed. New York, N.Y.: McGraw-Hill Education; 2016. https://www.accessmedicine.mhmedical.com. Accessed April 2, 2018.
  6. Wong RJ, et al. Evaluation of unconjugated hyperbilirubinemia in term and late preterm infants. https://www.uptodate.com/contents/search. Accessed April 2, 2018.
  7. Maisels MJ. Managing the jaundiced newborn: A persistent challenge. Canadian Medical Association Journal. 2015;187:335.
  8. Muchowski KE. Evaluation and treatment of neonatal hyperbilirubinemia. American Family Physician. 2014;89:87