by Dr. Pamela Bandelaria, pediatrician

A yellowish color of the skin (also called jaundice) sometimes affects babies. In most cases, this is a normal phenomenon and usually resolves on its own or with a little help from the sun. However, there are certain instances when a yellow color may be a sign of an underlying disease. If not detected and treated early these can have bad consequences for your baby. 

Jaundice is caused by an accumulation of fat-soluble bilirubin (indirect or unconjugated bilirubin) in the skin. Usually, it appears on the 2nd or 3rd day of life. If the baby is feeding well and does not have any other signs and symptoms of problems, the baby can just be observed until the yellowish color resolves by the 7th day. This type of jaundice is called physiologic jaundice and occurs in many infants. 

However, there are several diseases that can present as jaundice. When this occurs, the baby must be evaluated promptly and managed appropriately to avoid complications. A yellowish color needs the evaluation of a physician depending on the time of onset, duration, and associated signs and symptoms. A yellowish color of the skin within the first 24 hours is a cause of concern and must be evaluated. This is because jaundice within 24 hours of life may be attributed to infections, internal bleeding (hemorrhage), or blood type incompatibility. 

Other causes of jaundice may be due to gastrointestinal disorders that lead to persistent yellowish discoloration that can last weeks or months. This is why a yellowish color persisting for more than two weeks of life must be evaluated. Bilirubin levels in these cases are usually high. In biliary atresia, timing is important as the lifesaving treatment is surgery. Early diagnosis can spare the baby from liver failure and a liver transplant. 

Jaundice associated with any kind of symptom should also warrant an evaluation with your physician. Symptoms include: fever, poor suck or decreased feeding, poor activity and difficulty in arousal, seizures, weak cry, signs of respiratory distress or difficulty of breathing, vomiting, or diarrhea. These may be caused by various illnesses such as infection in the blood (sepsis), metabolic disorders, hypothyroidism, blood incompatibility, or other disorders leading to hemolysis (destruction of red blood cells) and must be assessed promptly.

The biggest complication that is associated with elevated bilirubin levels is brain dysfunction as the bilirubin, being fat-soluble, can easily deposit in the brain. This can cause seizures and irreversible damage if not treated. Severe brain damage associated with high bilirubin levels is called kernicterus and can be life-threatening. This is most likely to occur when the bilirubin levels are higher than 20mg/dL. Usually, this is the level when the yellowish color reaches the soles of the baby’s feet. If you see this in your baby, or if there is a fast progression of jaundice through the whole body, it is best to have them checked. 

Jaundice is usually not a cause for concern for most babies. However, it is important to know the warning signs so that you know when to bring your baby to the doctor.  

References:

• J.M. Pascual. (2014). Kernicterus. Encyclopedia of the Neurological Sciences. 801-804: Retrieved December 2020: https://www.sciencedirect.com/topics/neuroscience/kernicterus 

• Kliegman, R. St Geme, J. Blum, N. Shah, S. Tasker, R. Wilson, K. Behrman, R. (2019). Nelson textbook of pediatrics (Edition 21.). Philadelphia, PA: Elsevier.

• Mitra S, Rennie J. Neonatal jaundice: aetiology, diagnosis and treatment. Br J Hosp Med (Lond). 2017 Dec 2;78(12):699-704. doi: 10.12968/hmed.2017.78.12.699. PMID: 29240507.

• Reiser DJ. Neonatal jaundice: physiologic variation or pathologic process. Crit Care Nurs Clin North Am. 2004 Jun;16(2):257-69. doi: 10.1016/j.ccell.2004.02.010. PMID: 15145371.

• Woodgate P, Jardine LA. Neonatal jaundice. BMJ Clin Evid. 2011 Sep 15;2011:0319. PMID: 21920055; PMCID: PMC3217664.