by Olaide Akande

Created on: August 23, 2009   Last Updated: August 24, 2009

Some newborns get a yellowish coloration of their skin and sclera (white of the eye) following birth. This is known as jaundice and is due to excess amounts of the substance called bilirubin in their blood. Bilirubin is formed from the normal break down of old red blood cells the body no longer needs.

Often times, the cause of this build up is not serious and is due to physiological reasons. Other times however, it may be as a result of medical conditions. Whether your infant's jaundice is caused by a disease or otherwise will be determined by your doctor. Most hospitals monitor the levels of bilirubin in all newborns before discharge.

Physiologic causes of jaundice (Jaundice not due to disease)

Jaundice caused by physiologic reasons usually become noticeable on the second to third day of life, becoming most intense around the fifth day and gradually fading thereafter. A key characteristic of jaundice caused by disease is that it may appear as early as the first day of life.

Several factors contribute to why a newborn infant may get jaundice. These factors are due to immaturity of the systems responsible for handling the pathway from red blood cell breakdown to excretion of bilirubin.

Red blood cells of infants are more than those of adults, and their life is span shorter. Both of these contribute to an increased rate of breakdown to bilirubin. Furthermore, the liver responsible for clearing the bilirubin from the blood is also not yet as efficient in performing this function. These two factors combine to cause high bilirubin leading to jaundice.

Jaundice associated with breastfeeding

Breastfed babies may also have jaundice for two reasons. One is called breastfeeding jaundice. This type is seen in situations where breastfeeding has not been adequately established. The infant doesn't get enough fluid calories and this leads to jaundice.

The other is breast milk jaundice, and is due to substances present in breast milk which cause a reversal of the process facilitating excretion. One of the substances identified is the enzyme glucuronidase. This breaks down soluble, readily excreted bilirubin back to the insoluble form which then re accumulates in the blood thereby leading to jaundice.

Breast milk jaundice can only be diagnosed when all other possible causes have been excluded, breastfeeding has been well established, and infant is demonstrated to be gaining weight adequately. Treatment does not often involve having to stop breast feeding, however supplementation

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