Are you surprised to know all newborns will have a bit of jaundice? The question is how much! When your baby is born, her gastrointestinal system hasn’t started functioning yet. This includes her liver. The liver is the garbage disposal of the body, directing waste out through the stool. All babies are born with more red blood cells than they need. When they are broken down, they create a toxin called bilirubin in the bloodstream. This toxin is excreted by the liver, but the liver is slow to get moving. As bilirubin builds up in the bloodstream, it can become harmful to the baby. The initial signs include yellowing of the skin, mild irritability, and increased sleepiness. Moderate signs include lethargy, severe irritability, and crying, reluctance to eat, and yellowing of the eyes. The most harmful effect is the yellowing of the baby’s brain, causing brain damage. This is very rare.

There are a few factors affecting how much jaundice your baby will have. Prematurity, mom, and baby having different blood types, large amounts of bruising at birth, not enough feeds in the first few days, and race. All babies will be tested for jaundice at 24 hours of life and periodically thereafter. Babies with risk factors will be tested even earlier and more often.

The initial treatment/prevention is easy: feed the baby, feed the baby, feed the baby! Ensure you are feeding your baby enough times in a 24-hour period. Offer the breast at least 8-12 times in a 24-hour period. Let the baby cluster feed on demand, as long as the feeds are effective with big sucks and swallows. If the baby is flutter-sucking or the latch is painful, the feed is not effective. If you have done antenatal hand expression and brought your colostrum to the birth, supplement with a few milliliters after each feeding. Avoid pacifier use for breastfed babies for the first 3 weeks. If you are formula feeding, offer the baby a feed every 3-4 hours in a 24-hour period. Baby’s stomachs only hold 5-7 milliliters at birth, so it doesn’t need to be a lot. Increase the volume of feeds slowly as the baby tolerates it.

The next level of treatment will be supplementation and an increased number of feedings. There are a few options for this. Feed hand expressed or pumped breastmilk, donor breastmilk, or formula after each breastfeed. Mom gets to choose which type of supplement to give. If the baby is already formula-fed, then the frequency and amount of formula per feeding will be increased. 

Based on how many hours old the baby is, the bilirubin level, and the risk factors, the provider may order phototherapy. The baby will be placed under blue lights with only her diaper on to maximize exposure to the therapy. The baby will wear tiny goggles to protect her eyes. Her vital signs will be monitored more often. Feedings and time away from the lights will be monitored closely. A pacifier may be offered at this time to help keep the baby calm under the lights between feedings.

The last levels of treatment are additional lights, IV fluid therapy, and complete blood exchange transfusions. Don’t worry though, this level of treatment is rarely necessary! These treatments must be done in a higher level of care nurseries, such as special care or NICU.

All babies will have a bit of jaundice, but there are things you can do to reduce the risk and give your baby the best start!