FAMILY HEALTH Parenting Infants • Colic • Diaper rash • Infant jaundice • Spina bifida • Ventricular septal defect (VSD) • Tetralogy of Fallot • Coarctation of the aorta • Umbilical hernia • Ambiguous genitalia • Cleft lip and cleft palate • Infant acid reflux • Pyloric stenosis • Undescended testicle (cryptorchidism) CHILDREN'S HEALTH Infants • Colic • Diaper rash • Infant jaundice • Spina bifida • Ventricular septal defect (VSD) • Tetralogy of Fallot • Coarctation of the aorta • Umbilical hernia • Ambiguous genitalia • Cleft lip and cleft palate • Infant acid reflux • Pyloric stenosis • Undescended testicle (cryptorchidism)

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In their first few days of life, more than half of all full-term babies and as many as four out of five premature infants who are otherwise healthy develop jaundice, a yellowish discoloration of the skin and eyes. Although some babies are jaundiced at birth, most develop infant jaundice during their second or third day of life. That's why you may not notice it until after your baby is home.

Infant jaundice itself isn't a disease. In most cases it occurs because your baby's liver isn't mature enough to metabolize a molecule called bilirubin, which normally forms when the body recycles old or damaged red blood cells.

Infant jaundice usually isn't a cause for alarm. It doesn't cause discomfort for your baby, and it usually disappears on its own in one to two weeks. Still, infant jaundice should be closely monitored by your baby's doctor because severe jaundice can lead to serious complications. Treatments can help keep your baby's blood level of bilirubin from becoming too high.

In most babies, signs and symptoms of infant jaundice appear in the second or third day of life and include:

• Yellowing of the skin
• Yellowing of the eyes
• Lethargy, in some cases

You'll usually notice jaundice first in your baby's face. Later, his or her chest, stomach and legs also may turn yellow. An easy way to test for infant jaundice of any race is to gently press your finger on your baby's forehead or nose. If the skin looks yellow where you pressed, it's likely your baby has jaundice. It's best to examine your baby in natural daylight. In addition to checking for yellow skin, note whether the whites of your baby's eyes also are yellow.

Infant jaundice commonly lasts for a week to 10 days in full-term newborns. If your baby is premature or if you breast-feed your baby, jaundice may last longer.

Babies are born with a generous supply of red blood cells, which help transport oxygen. Over time, these red blood cells break down, forming bilirubin in the process. Bilirubin is normally transported to the liver where it's processed before being eliminated from the body. But newborns initially have more bilirubin than their livers can handle, and the excess causes their skin, and sometimes the whites of their eyes, to turn yellow. This type of jaundice, called physiologic jaundice, typically appears on the second or third day of life. Although any newborn can develop physiologic jaundice, it occurs more often, and is sometimes more severe, in premature babies because their livers are even less developed than are those of full-term infants.

Sometimes a baby may develop jaundice for other reasons. If jaundice is present at birth or appears within 24 hours, it may be the result of:

• Severe bruising
• An infection in your baby's blood (sepsis)
• An incompatibility between your blood and your baby's

Jaundice that develops in or lasts past the second week of life may be due to:

• A liver malfunction
• A severe infection
• An enzyme deficiency
• An abnormality of your baby's red blood cells

Boy babies tend to be at higher risk of infant jaundice than are girls. Asian and American Indian infants also are more likely to have jaundice. Other factors that may put your newborn at risk of jaundice include:

• Premature birth. Because your premature baby may not be able to process bilirubin as quickly as full-term babies do, he or she is at higher risk of jaundice. Your preemie may also feed less at first and have fewer bowel movements, which means less bilirubin is likely to be eliminated in your baby's stool.
• Bruising during birth. Sometimes babies are bruised during birth. If your newborn has a bruise, he or she may have a higher level of bilirubin from the breakdown of more red blood cells.
• Blood type. If your blood type is different from your baby's, your baby may have received antibodies through the placenta that cause his or her blood cells to break down more quickly. Blood groups are determined according to whether you have certain protein molecules on the surface of your blood cells. The rhesus (Rh) factor is one of these blood groups. If you have the Rh factor in your blood cells, you're considered Rh positive. If you don't, you're Rh negative. There's nothing inherently wrong with being either Rh positive or Rh negative. But problems can arise when an Rh-negative woman is pregnant with an Rh-positive baby. During pregnancy, fetal cells cross the placental barrier and mix with the mother's cells. If the mother's immune system detects the baby's opposing Rh factor, it produces antibodies against it. These antibodies then attach to the baby's red blood cells, causing them to break apart and release bilirubin. To minimize the likelihood of problems, Rh-negative women receive injections of Rh-o (D) immune globulin (RhoGAM), which prevents the mother's body from producing unwanted antibodies, during the pregnancy and immediately following birth.
• Breast-feeding. Breast-fed babies have a higher risk of jaundice, but for most newborns the risk is slight and is far outweighed by the benefits of breast-feeding. In addition, if a mother's milk is slow to let down, her baby may not gain weight as readily, which makes jaundice more pronounced. Breast-feeding more than the daily usual of eight to 10 times, which will encourage your baby to have more bowel movements, might reduce the risk. Breast-milk-related jaundice normally appears four to seven days after birth and may last for several weeks.
• Early discharge from the hospital. Because bilirubin levels tend to rise during the second and third days of life, babies who are released from the hospital less than 72 hours after birth are at increased risk of developing jaundice after they're home. Before early discharges were common, jaundice was usually recognized and treated in the hospital nursery.

During the first few days after your baby goes home, be alert for the development of jaundice. Call or see your baby's doctor if your newborn develops jaundice or begins to look or act sick. Be sure to check with your baby's doctor if your newborn's jaundice is severe:

• If the skin is bright yellow
• If it lasts longer than one or two weeks
• If your baby isn't gaining weight
• If your baby develops any other symptoms that concern you

If your baby was born at 36 to 38 weeks gestational age — several weeks early — be particularly careful to watch for the development of jaundice or poor feeding. Babies born in this age range have a higher likelihood of needing medical treatment for infant jaundice after their discharge from the hospital. Arrange with your doctor to have the baby's weight checked within several days after going home. This makes it easy to monitor both weight gain and jaundice. Don't hesitate to ask about having your baby's weight checked: It's easy, quick to do and reassuring.

Your doctor will likely diagnose infant jaundice on the basis of your baby's appearance. He or she may also take a small sample of your baby's blood to measure the bilirubin level.

A device that measures bilirubin through the skin (transcutaneous bilirubinometer) may be useful in screening newborns for jaundice. The device measures the reflection of a special light shone through the skin and eliminates the need to take a blood sample.

Your baby may have additional blood tests if the jaundice requires treatment or if you and your baby have different blood types.

When bilirubin reaches extremely high levels, especially in newborns ill enough to require treatment in a newborn intensive care unit, it can lead to a rare, but very serious, condition called kernicterus. This disorder causes damage to a newborn's brain, and may lead to deafness, severe developmental disabilities and an unusual form of cerebral palsy.

Especially if your baby was born early, be watchful for signs and symptoms of severe jaundice, such as:

• Deep yellow or orange skin tones
• Extreme sleepiness so that it's hard to wake your baby
• High-pitched crying
• Poor sucking or nursing
• Weakness or limpness

Mild infant jaundice often disappears on its own within a week or two. But if your baby has moderate or severe jaundice, he or she 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 ultraviolet light or wrapped in a fiber-optic blanket of light. The light changes the bilirubin into a form that can be eliminated by your baby's kidneys. Newborns with jaundice typically receive phototherapy for several days.
• Intravenous immunoglobulin (IVIg). If moderate to severe jaundice develops because of blood group differences between mother and baby, an intravenous transfusion of antibodies may decrease the jaundice and lessen the need for exchange blood transfusion.
• Exchange blood transfusion. In extremely rare cases, 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 out" the bilirubin and maternal antibodies, and then transferring the blood back into the baby — a procedure that's performed in a newborn intensive care unit.

When infant jaundice isn't severe, the following may help lower your newborn's bilirubin level:

• More frequent feedings. Feeding more frequently will provide your baby with more calories and cause more bowel movements, increasing the amount of bilirubin passed in your baby's stool.
• Formula milk. Temporarily supplementing breast milk with formula or changing to formula, even for only one or two days, may quickly lower your baby's bilirubin level. You can use a breast pump to express your milk until you start breast-feeding again. Some doctors hesitate to suggest this approach, however, because they don't want to interfere with your efforts to breast-feed your baby. Another option is to "top off" the breast-feeding by offering an ounce or two of formula at the end of each breast-feeding for a week.