Jaundice

Children with jaundice often have a yellowish tint of the eyes and skin that usually begins on the face and moves down the body.

Jaundice is a sign of a condition called hyperbilirubinemia. Babies and children develop hyperbilirubinemia when a waste product called bilirubin builds up in their blood. In newborns, hyperbilirubinemia is often a temporary condition, though it can be a symptom of a more serious illness. Early recognition and treatment are important to keep bilirubin from rising to dangerous levels.

Jaundice is common in newborns whose livers are still developing. More than half of full-term babies have jaundice in their first week. Up to 80 percent of infants born premature have jaundice.

In older children, jaundice can be a more serious symptom of liver disease.

Bilirubin is a brownish, yellowish substance produced by the breakdown of red blood cells. During pregnancy, the placenta excretes bilirubin. A baby’s liver must take over this function once the baby is born. The coloring of the bilirubin causes the baby’s eyes and skin to appear yellow.

There are several reasons a newborn can develop jaundice, including:

• Physiologic jaundice is a normal response to a baby’s limited ability to excrete bilirubin in the first days of life.
• Breastfeeding jaundice occurs in some babies in the first week due to low milk intake or dehydration.
• Breast-milk jaundice occurs in some babies in the second week of life or later for unknown reasons. It may be related to a substance in the breast milk that makes it easier for the intestine to reabsorb the bilirubin or due to the immature liver processing of bilirubin.
• Jaundice from hemolysis is a condition that results from excess breakdown of red blood cells due to hemolytic disease of the newborn (HDN), polycythemia, or hemorrhage.
• Inadequate liver function due to infection or other factors.

In most cases of breastfeeding jaundice and breast-milk jaundice, doctors recommend that the mother continue breastfeeding.

In a small number of cases, jaundice in a newborn can be a sign of:

• Cholestasis, a rare condition caused by a problem with the production or flow of bile
• Biliary atresia, a rare condition in which the duct that carries bile from the liver to the small intestine is blocked or damaged

Jaundice in older children can be the sign of an obstruction in the biliary ducts. Or it may be due to a liver condition that is preventing the liver from processing the bilirubin appropriately.

The following conditions can also cause jaundice in older children:

• Gallstones (cholelithiasis), crystals that build up in the gallbladder and obstruct the biliary duct
• Infection with the viruses that cause liver cell damage such as hepatitis B or hepatitis C virus
• Autoimmune hepatitis, a disorder of the immune system that causes immune cells to attack the liver cells as if they were an infection
• Wilson disease, a genetic condition in which copper from food builds up in the liver
• Cirrhosis, a late stage of chronic liver disease in which scar tissue replaces soft, healthy liver tissue

Newborns

Jaundice that appears in the first 24 hours of an infant’s life is quite serious and usually requires immediate treatment. Jaundice that appears later can be normal and often clears up without treatment. However, persistent jaundice beyond the second week of life can be sign of a more serious liver problem that needs to be assessed by a doctor.

Newborns and older children

No matter what the age your child is, their doctor will conduct a physical exam and look for visible signs of jaundice. The doctor may also conduct the following tests to determine why your child has jaundice:

• Blood test to measure bilirubin levels and red blood cell counts
• Coomb's test to identify antibodies that attack red blood cells

Your child’s doctor will decide how to treat jaundice based on many factors, including the underlying cause and results of the blood tests. While jaundice cannot be prevented completely, early treatment is important to keeping bilirubin from rising to dangerous levels.

Treatment for newborns may include one or more of the following: 

• Phototherapy uses blue spectrum light to reduce bilirubin levels. This type of light transforms bilirubin into a water-soluble compound that can be excreted in the urine. This treatment may take several hours, during which a clinician will change your baby’s position frequently to allow full skin exposure to the light. Your baby’s eyes will be protected, and clinicians will monitor their temperature and bilirubin levels throughout the treatment.
• Fiberoptic blanket is a type of phototherapy in which a fiberoptic blanket, also known as a biliblanket, is placed under your baby. The fiberoptic blanket bathes the baby in light to reduce bilirubin. It can be used alone or in combination with standard phototherapy.
• Exchange transfusion is a medical procedure used to reduce levels of bilirubin. During the treatment, a clinician gives and withdraws blood from the child in small amounts. This treatment may need to be repeated if bilirubin levels remain high.
• Discontinued breastfeeding for breast-milk jaundice is usually only necessary for one or two days. Breastfeeding can be resumed after bilirubin levels go down.
• Other treatments focus on managing the underlying cause of jaundice and reducing bilirubin levels.

The Center for Childhood Liver Disease at Boston Children’s Hospital specializes in treating infants, children, adolescents, and young adults for a wide variety of liver, gallbladder, and bile duct disorders (otherwise known as hepatobiliary). Doctors from all over the world refer children with liver disease to our program.