have you looked back on baby pictures of you or your little one and notice that y'all looked kind of yellow in those early days today we're going to go over different causes of this color change which is termed jaundice that yellowing of the skin that we can commonly see in babies it's most common in newborns but can develop an older infants and children as well we'll talk about some myths surrounding neonatal or newborn jaundice like is it caused by vaccines which it certainly is not what to look for if your infant appears jaundice as well as ways it can be managed we'll also cover when it's important to seek medical attention so make sure you stick around until the end I am Dr Mona a board-certified pediatrician and Mom and I help Empower parents with easy to understand information so that you can make the best choices for your children if you are expecting a baby or have a baby under one year of age make sure to check out my new mom survival guide which helps mothers and their Partners navigate all things first year of Parenthood jaundice is the medical term for yellow discoloration of the skin and the white parts of the eyes it is caused by a buildup of bilirubin in the blood our body is constantly making new red blood cells and breaking down old ones red blood cells are broken down into different parts including bilirubin either spleen and liver the bilirubin is then processed by the liver secreted into bile a flu that aids in digestion and is moved from the liver to the gallbladder where it is stored until it is transported to the intestines it is then removed from the body through stool and urine bilirubin is a yellowish pigment so if too much builds up in the blood it results in noticeable yellowing of the skin or jaundice almost all infants experience elevated levels of bilirubin after birth due to a combination of factors boards have an immature liver like everything else is immature that is not able to process bilirubin as effectively they also have a higher rate of red blood cell breakdown leading to increased bilirubin production this jaundice is called physiologic jaundice because it happens due to the typical development of a newborn as the newborn's liver develops and the rate of red blood cell breakdown declines bilirubin levels fall and return to a normal level for the baby as those levels fall jaundice disappears so you may hear clinicians say the jaundice level is normal or bilirubin level is normal as these phrases are often used interchangeably but remember bilirubin is a substance and that lab can be measured and jaundice is the clinical presentation about 60 percent of all infants will show some degree of jaundice yes it's high and very common Yours Truly actually had jaundice as a newborn and had to get light therapy or phototherapy in the hospital which we will get into so if your baby is dealing with this know that it is very common and that you're not alone and it is not your fault we screen every single baby in a hospital for jaundice by getting this bilirubin level because of how common it is in newborns some risk factors make babies more likely to experience jaundice these include prematurity bruises from delivery and scalp hematomas from delivery family history blood type incompatibilities and race a pre-term baby or an infant born before 38 weeks of gestation may not be able to break down bilirubin as quickly as their full-term infants due to an even more immature biliary liver threat pre-trub infants also often have a harder time feeding and therefore can have decreased urine and stool output leading to that decreased bilirubin excretion so yes feeding is important to help bilirubin get eliminated bruising also called hematomas can increase the risk of jaundice babies can have swelling on their head called a cephalo hematoma from the trauma of delivery a cephala hematoma is a collection of blood under the scalp the blood is slowly absorbed and as the red blood cells are broken down in the body bilirubin levels rise this typically is a gradual process and the swelling typically disappears within a few weeks or months but monitoring jaundice is really important in these children a family history of a parent or sibling requiring phototherapy as an infant increases one's risk another risk is blood type incompatibility if a mother and infant have specific different blood types maternal antibodies can leak into the baby's blood system resulting in increased red blood cell breakdown and therefore jaundice an example of this is something called incompatibility this condition can show up if a mother has type O blood and her baby has a b or a B type blood this is why OBS will typically check blood types during pregnancy to determine if intervention is needed to stop these antibodies from being produced if you want more information about compatibility comment below so I can make a video for you finally studies show that babies of East Asian ancestry have an increased risk of developing jaundice hi I'm East Asian and I had it followed by Native American Caucasians and African-American babies you may have heard a myth out there that vaccines can cause jaundice this is absolutely not true there's no evidence to support this this myth likely stemmed from the fact that many babies get the hepatitis B vaccine in the hospital shortly after birth and this is around the same time that jaundice just typically presents in newborns there is no evidence to show that babies who receive Hepatitis B after a bird have increased rates of jaundice and it should definitely not be a reason to decline or postpone immunization so physiological jaundice refers to Common expected jaundice as mentioned already due to immaturity of the baby's biliary system pathologic jaundice refers to jaundice that is out of the ordinary but both require us to evaluate and monitor physiologic jaundice appears after 24 hours of life which is why labs for bilirubin are drawn routinely at 24 hours to 48 hours of life to confirm that the levels are not elevated your clinician in the hospital or in the office may also recommend checking bilirubin levels if your child is appearing more yellow just to confirm that the bilirubin levels are not high pathological jaundice appears within 24 hours of Life The Rise is fast from day to day and the child may have clay or white colored stools jaundice is monitored closely in the first two weeks of life after delivery as well as at the clinician's office to determine if labs are needed or intervention with physiologic jaundice the bilirubin levels typically Peak about day three to four after birth and then slowly fade and resolve on their own by two to three weeks hospitals will typically check your baby's bilirubin levels between 24 to 48 hours after birth either by scanning their skin or testing a blood test this number will put them in a risk category and that will determine how frequently they'll want to check their levels we look at something called a bilirubin normogram which looks at Levels by age and also accounts for various risk factors babies are entitled to have higher levels than preterm babies or babies with APO and compatibility or other risks the clinician will look at the value and match it with how many hours or days old your baby is and other risk factors to determine if levels need to be rechecked how often levels need to be checked or if any intervention is needed at all infants who are low risk will not need any intervention and will likely not need their level checked again for infants at high risk for their day of life and risk factors the clinician May recommend something called phototherapy this is a treatment with a special ultraviolet light that is absorbed through the skin and helps transform the bilirubin into products that are easier to remove from the body in the hospital babies typically lay in a bassinet with a layer of UV light suspended above them with these little sunglasses babies should be in minimal clothes typically only a diaper when they're receiving phototherapy to maximize Exposed Skin to help phototherapy be more effective the baby can be removed from the bassinet for feedings and placed back in when they're done if a baby is already discharged from the hospital some clinicians will order a billy blanket to be used at home which can actually reduce the need for light therapy for borderline High cases your clinician should advise you on what the best treatment is for your child and how to use it depending on their clinical symptoms and clinical case of jaundice you may be wondering why we care so much about this every baby gets it what's the big deal it will resolve on its own within a few days anyway in some cases but if bilirubin levels get too high a rare but serious complication called connectoris can occur connectorus is caused by bilirubin accumulation in the brain resulting in damage to the brain or central nervous system to prevent this clinicians monitor bilirubin levels and use phototherapy to speed up the clearance of bilirubin if the level is getting close to risky thresholds so please do not deny testing for biliruba levels sometimes it can be hard to visually see the yellowness or jaundice in the skin on darker skinned babies and every baby should get a level checked at 24 to 48 hours of life or if clinically indicated before or after that time period because with proper screening we do not see connectors in developed countries in severe cases of jaundice where the child is not responding to phototherapy and sometimes they may put one light or double lights on your child a baby may need to be transferred to the NICU for something called exchange transfusion exchange transfusion is a life-saving procedure that is done to counteract the effects of severe jaundice the procedure involves slowly removing the person's blood and replacing it with tested fresh donor blood or plasma and has no long-term consequences and this is something that I've seen done in some cases of jaundice indirect sunlight can help break down bilirubin similar to receiving phototherapy however it is not always the full treatment if your child has a borderline high levels or moderate levels of jaundice that do not need a light therapy in a hospital or a blanket your clinician May recommend putting your baby in a bassinet or carrying them near a window to receive indirect sunlight indirect means not going outside where the sun rays can be stronger for babies young and sensitive skin yes feeding your baby can help eliminate jaundice whether your child is receiving phototherapy or not they will be fed with breast milk or formula whatever they are receiving in some cases if the baby seems dehydrated they may also get IV fluids on top of feedings by mouth foreign there are rare causes of jaundice these include problems with the liver intestines infections blood disorders that result in too much red blood cell breakdown or enzyme deficiencies reducing the body's ability to get rid of bilirubin if your clinician is concerned about therapies such as Billy blankets or phototherapy or maybe even exchange transfusions not working or high levels that are not resolving they may Order special Labs or Imaging to assess these causes if your baby has jaundice and you are breastfeeding you may have heard the terminologies breast milk or breastfeeding jaundice which are actually very unique conditions breastfeeding jaundice occurs to difficulties with breastfeeding or with poor milk transfer in the days after birth remember if there is inadequate milk transfer or milk intake infants will not take in enough fluids to have adequate output to clear bilirubin through stool or urine if there are signs of inadequate intake like not enough wet diapers or slow weight gain intervention may be needed your clinician may discuss increasing the frequency of feeds seeing a lactation Specialist or supplementing with formula for the time being to increase the intake to help clear bilirubin through more dirty diapers confusingly there is a separate type of jaundice called breast milk jaundice that affects about two percent of breastfed babies this jaundice is caused by the breast milk itself breast milk jaundice isn't well understood but it is believed that in some babies the substances in breast milk can reduce the liver's ability to process and eliminate bilirubin effectively it typically presents in the first week of life and can take up to 12 weeks to resolve I usually see it resolved by four weeks six weeks it is important to distinguish between breastfeeding jaundice where the lack of milk is the driving factor in breast milk jaundice babies will be feeding well gaining good weight and otherwise acting well this jaundice rarely needs intervention and should resolve over time but your clinician may still want to monitor their bilirubin by checking their blood level from time to time and monitoring Trends if we feel this is breast milk jaundice I typically encourage breastfeeding and to monitor bilirubin levels if the levels are getting too high and any other etiologies have been eliminated occasionally we may recommend to to pause breastfeeding continue pumping and provide formula to help eliminate the substances in breast milk causing this jaundice for this young baby truly there is no right or wrong as we understand more about breast milk jaundice so work with your clinician on what makes sense for you and your breast milk production like I mentioned I've seen breast milk jaundice last anywhere from 4 to 12 weeks and is meant monitoring of jaundice levels weight and further labs to confirm the diagnosis is correct and that baby as well there you have it jaundice is so common in that newborn or neonatal period but often results in stress worry and guilt for parents I hope this video helped explain why jaundice happens what to monitor for why it's not your fault and when to see your clinician if 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