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What Causes Jaundice

Jaundice or icterus describes yellow skin and yellowness of the white part of the eye (the sclerae). The yellow color appears when the level of blood pigment, bilirubin, is increased. Bilirubin is the name of a chemical breakdown product of the hemoglobin protein found within the red blood cells. Red blood cells wear down with time and are constantly being replaced. As the old cells are broken down, bilirubin is produced. When bilirubin levels become high enough as during the newborn period, or due to illness or disease states, a yellow discoloration of the skin (jaundice) or of the whites of the eyes (icterus) can be seen.

In the otherwise well newborn, only very high levels of bilirubin are thought to be harmful. In older children, the bilirubin itself is not thought to be harmful; however, it is an indicator of illness that needs evaluation.

An increased level of bilirubin in the blood, causing jaundice, can be from many different causes, some of which are listed below. This list is not exhaustive.

  • Destructive (hemolytic) anemia such as sickle cell disease
  • Viral hepatitis
  • A side effect of certain drugs such as rifampin and probenecid
  • Normal or physiologic jaundice of the newborn
  • Breast milk jaundice
  • Breast feeding jaundice
  • Hereditary syndromes:
  • Gilbert syndrome
  • Crigler-Najjar syndrome
  • Dubin-Johnson syndrome
  • Rotor syndrome
  • Impaired bile flow from liver or pancreatic cancer
  • Liver failure from hepatitis or toxic injury from a drug overdose such as Tylenol

Normal newborn jaundice or physiologic jaundice occur in 60-70% of all newborn babies. It is caused by an increase in the blood level of bilirubin because the newborn’s liver is not yet equipped to clear the bilirubin pigment from the blood. As the liver matures, it is able to clear the bilirubin. The elevated bilirubin level and jaundice last no more than 3 weeks. In the majority of cases, no treatment is necessary. On occasion, when bilirubin levels are very high (over 20), it is necessary to treat this form of jaundice with external lights–”bili lights”. Today, this can usually be done at home, if the bilirubin level is not too high. For levels over 24 or 25, your baby’s pediatrician will likely choose to admit your baby to the hospital for intensive “bili light” therapy and observation. In premature babies, there is a risk of kernicterus with high bilirubin levels. Kernicterus occurs when bilirubin has entered the brain and injured brain cells. This is very rare in full term babies.

Breast milk jaundice refers to a specific cause of jaundice. It usually is diagnosed around two weeks of age when physiologic jaundice should be about gone. It occurs in some infants whose main source of food is breast milk. The cause is not certain, but believed to be caused by a substance within the breast milk which either slows the liver’s ability to secrete the bilirubin into the bowels for eventual excretion from the body or increases the bowels’ absorption of bilirubin back into the blood stream.

Rarely is breast milk jaundice of any harm, but still levels of bilirubin should not be allowed to get too high, and evaluation by your baby’s doctor is necessary.

Breastfeeding jaundice is an amplification of physiologic jaundice of the newborn occurring within the first few days of life. It is related to the relatively low amounts of breast milk that are available for consumption by the newborn before the mother’s milk “comes in”. A relative state of dehydration combined with slowed bowel transit results in elevated bilirubin levels. Often, no treatment is required, but your baby’s doctor needs to be aware of the jaundice and can judge whether any blood tests or further evaluation is needed.