Newborn Jaundice

Yellowing of the skin and the whites of the eyes is a sign of infant jaundice that usually appears between the second and fourth day after birth. To check for infant jaundice, press gently on your baby’s forehead or nose. If the skin looks yellow where you pressed, it’s likely your baby has mild jaundice.

Serum Blood Test

Normal values of total bilirubin are from 0.3 to 1.0 mg/dl. In a newborn, higher bilirubin is normal due to the stress of birth. Normal bilirubin in a newborn would be under 5 mg/dl, but many newborns have some kind of jaundice and bilirubin levels above 5 mg/dl

In general, a total bilirubin level above 1.9 mg/dl is considered elevated. The normal range for total bilirubin level in the blood is 0.3 to 1.9 mg/dl. Direct, or conjugated, bilirubin normally ranges from 0 to 0.3 milligrams per deciliter.

Before treatment is initiated, the minimum evaluation should include the infant’s age and postnatal course, a maternal and gestational history, physical examination of the infant, and determination of the total serum bilirubin level and the rate at which it is rising.

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).

Phototherapy should be instituted when the total serum bilirubin level is at or above 15 mg/dl (257 mol/l) in infants 25 to 48 hours old, 18 mg/dl (308 mol/l) in infants 49 to 72 hours old, and 20 mg/dl (342 mol/l) in infants older than 72 hours.

Light treatment is the process of using light to eliminate bilirubin in the blood. Your baby’s skin and blood absorb these light waves. These light waves are absorbed by your baby’s skin and blood and change bilirubin into products, which can pass through their system.

Phototherapy employs blue wavelengths of light to alter unconjugated bilirubin in the skin. The bilirubin is converted to less toxic water-soluble photo-isomers that are excreted in the bile and urine without conjugation. The decision to initiate phototherapy is based on the newborn’s age and total serum bilirubin level.

Another bilirubin level will be checked 12–18 hours later to make sure it hasn’t risen again. Babies usually need to be under phototherapy lights for around 48 hours and often longer.

The efficacy of phototherapy depends on several important factors. The ideal configuration is four special blue bulbs (F20T12/BB) placed centrally, with two daylight fluorescent tubes on either side. The power output of the lights (irradiance) is directly related to the distance between the lights and the newborn. Ideally, all lights should be 15 to 20 cm from the infant. To expose the greatest surface area, the newborn should be naked except for eye shields. For double phototherapy, a fiber-optic pad can be placed under the newborn. This method is twice as effective as standard phototherapy.

Physiological jaundice normally clears by the time your baby is two week’s old.

Phototherapy will be stopped when the bilirubin level falls to a safe level, which usually takes a day or two. Phototherapy is generally very effective for newborn jaundice and has very few side effects, although your baby may develop a temporary rash or tan as a result of the treatment.

Potential problems that may occur with phototherapy include burns, retinal damage, thermoregulatory instability, loose stools, dehydration, skin rash, and tanning of the skin. Because phototherapy is continuous, treatment also involves significant separation of the infant and parents.

The only contraindication to the use of phototherapy is conjugated hyperbilirubinemia, as occurs in patients with cholestasis and hepatic disease. In this setting, phototherapy may cause a dark grayish-brown discoloration of the skin (bronze baby syndrome).