Jaundice in preemie newborns: What you need to know

What is newborn jaundice?

Jaundice happens when a yellow substance called bilirubin builds up in your baby’s bloodstream. In the body, red blood cells are constantly forming and breaking down. When they break down, they produce bilirubin. The liver breaks down bilirubin so that it can leave the body via urine and stool. 

If the liver isn’t working well enough, bilirubin doesn’t get removed and builds up in the bloodstream. This buildup of bilirubin causes jaundice and leads to a baby’s skin or the whites of their eyes looking yellow. 

What causes newborn jaundice?

If the liver doesn’t break down and remove bilirubin from the body like it should, it will build up and cause jaundice. The liver may not work as well as it should for several reasons:

• Immature liver function: Most babies have high bilirubin levels at birth because their livers are still developing. This is especially true for preterm babies born before 37 weeks.
• High breakdown of red blood cells: Babies make at least twice as much bilirubin as adults and remove bilirubin from the body more slowly.
• Breastfeeding-related jaundice in preterm newborns: Sometimes, jaundice happens if a baby doesn't get enough breast milk.

There is also a more severe form of jaundice that is caused by liver disease, Rh disease, and some genetic conditions.

Jaundice, breastfeeding, and breast milk

There are two scenarios where breastfed babies may develop jaundice:  

• A baby is not getting enough breast milk: If your baby is having a hard time getting milk, they may lose more weight, which can lead to higher bilirubin levels. This tends to happen during the first week of life when your baby is still learning to feed. Making sure your baby is latching well and breastfeeding often can help address breast milk jaundice.
• A baby is getting enough breast milk: A baby who is getting enough breast milk may have jaundice for similar reasons: their liver isn't fully developed. You do not need to stop breastfeeding if your baby is feeding well and gaining weight. This type of breast milk jaundice usually begins to resolve several weeks after birth.

What are the symptoms of jaundice in newborns?

The main symptom of newborn jaundice is yellow-tinted skin or eyes, especially two to four days after birth. 

If your baby’s jaundice is getting worse, symptoms can include:

• Yellowing of the skin below their knees or a stronger yellow-orange color
• Fever
• Having a hard time eating
• More sleepiness than usual or having a hard time waking up
• Irritability
• Arching their neck or body backwards

Can newborn jaundice cause complications? 

Some babies with jaundice have severe hyperbilirubinemia — dangerously high levels of bilirubin in the blood. An infant can develop this condition as soon as the first day after birth and will need prompt treatment if they do. If bilirubin levels are too high, serious complications can happen. Bilirubin can enter the brain and cause reversible or permanent brain damage:

• Acute bilirubin encephalopathy causes reversible brain damage.
• Kernicterus, or chronic bilirubin encephalopathy, causes permanent brain damage.

How is newborn jaundice diagnosed?

Jaundice can be diagnosed by looking at your baby for visual signs of jaundice or by checking bilirubin levels with a blood test. Sometimes, your baby will be screened for high bilirubin levels in the skin to determine whether they need a blood test.

Depending on your baby’s health, a doctor may perform additional tests to better understand the cause of their jaundice.

What are the treatment options for newborn jaundice?

In many cases, infant jaundice goes away on its own. A baby’s liver may take a week after birth, or longer, to fully mature. If your baby has mild jaundice, you and your pediatrician should monitor it over the first few days to weeks after birth to ensure it is getting better. 

More severe jaundice may require the treatments listed below. Treatment options include:

• Breastfeeding often
• Phototherapy (light therapy)
• Exchange transfusion in severe cases 

Feeding more often

Breastfeeding frequently is recommended since it helps speed up your baby’s body’s ability to remove bilirubin through urine and stool. Their bilirubin levels can also increase if your baby loses too much weight. So feeding often — or even supplementing feeds with formula, donor milk, or expressed breast milk — can help prevent this weight loss. 

Phototherapy

Phototherapy or light therapy, is a common way to treat high bilirubin levels in infants. A blue light helps break bilirubin into smaller parts that are easier for your baby’s body to get rid of through urine and stool. Your baby should be under the blue light nonstop unless they are being fed or are having skin-to-skin time. During this treatment, they will only wear a diaper and eye protection. 

Usually, babies get phototherapy in the hospital, but some healthy babies can get phototherapy at home. Once your baby’s bilirubin levels are in a safe range, phototherapy treatment ends. 

Possible side effects from phototherapy include rashes, loose stools, overheating, and dehydration if your baby doesn’t get enough fluids. Feeding your baby often during phototherapy helps prevent dehydration and overheating. If your baby gets seriously dehydrated, they may be given IV fluids.

Exchange transfusion

An exchange transfusion is an emergency procedure that rapidly lowers bilirubin levels. During the procedure, your baby’s blood is replaced with donated blood. This procedure is only for babies whose bilirubin levels do not improve with phototherapy or other treatments and whose risk for brain damage is high.

Are there ways to prevent infant jaundice?

Most jaundice cases resolve on their own, but it’s critical to prevent severe hyperbilirubinemia as it can cause brain damage. Strategies to prevent severe hyperbilirubinemia include:

• Screening all newborns before they are discharged from the hospital
• Parents and healthcare providers monitoring the baby for signs of jaundice during the early days and weeks after birth
• Treating high bilirubin levels without delay

If you have questions about your baby and jaundice, talk to your local pediatrician or text a Summer Health pediatrician anytime.