What is jaundice?
Jaundice causes a yellowing of the skin, mucous membranes, and the eyes. Jaundice, or icterus, is the result of a buildup of bilirubin in the blood. Jaundice occurs in both benign and life-threatening conditions. Bilirubin is a yellow-colored pigment that is produced by the breakdown of old red blood cells. Normally, the liver processes bilirubin and mixes it with a substance called bile. Then, the body gets rid of it through the feces.
Jaundice in newborn infants (neonatal jaundice)
It is not unusual for newborn babies to have yellowing of the skin and eyes due to a condition called newborn, or neonatal jaundice. Newborn jaundice is common and occurs in about 60% of all newborn babies.
In many cases, jaundice in babies is not a cause for alarm and requires no treatment. However, it is important to immediately notify your infant’s healthcare provider if you notice yellowing of the eyes or skin in your baby. The doctor may need to evaluate, monitor and treat your baby’s condition and bilirubin levels.
High levels or quickly rising levels of bilirubin in newborns can lead to serious or life-threatening complications, such as cerebral palsy and brain damage. Seek prompt medical care if you notice that your baby has jaundice. Early monitoring and jaundice treatment can reduce the risk of complications.
Seek immediate medical care (call 911) if your baby has symptoms, such as weak sucking, inability to feed, unresponsiveness, lack of wet or dirty diapers, a stiff or limp body, strange eye movements, severe jaundice, or difficulty waking up.
Jaundice in children and adults
In children and adults, jaundice occurs when bilirubin builds up because of serious diseases and conditions that cause liver damage or dysfunction, or block the bile ducts. The bile ducts transport bile to the digestive tract to be mixed with feces. Certain conditions of the gallbladder or pancreas, such as cancer, pancreatitis or gallstones, can also cause obstruction of the bile ducts that lead to jaundice.
Serious liver diseases include hepatitis and cirrhosis. Certain blood disorders, such as hemolytic anemia, can also cause jaundice because of the abnormal destruction of red blood cells and increase in bilirubin. Jaundice in adults and children is treated by diagnosing and treating the underlying cause.
Seek prompt medical care if you, or your child, have jaundice. Early diagnosis and treatment of the cause of jaundice can reduce the risk of serious complications, such as liver failure.
Seek immediate medical care (call 911) if you, or someone you are with, have symptoms that may be associated with jaundice, such as lethargy or unresponsiveness, confusion, difficulty breathing, swelling, or a change in consciousness or alertness. You should also seek immediate medical care (call 911) if you, or someone you are with, have overdosed on a drug or ingested a toxic substance. Drugs and toxic substances can lead to toxic hepatitis and liver failure.
What other symptoms might occur with jaundice?
Jaundice may accompany other symptoms, which vary depending on the underlying disease, disorder or condition. Children and adults with jaundice often have other symptoms of an underlying disease. However, newborn infants with mild jaundice often do not have any other symptoms.
In children, adolescents and adults, symptoms that may appear along with jaundice include:
- Dark or brown urine
- Itchy skin
- Malaise or generally feeling ill
- Pale or clay-colored feces (stool)
Symptoms that might indicate a serious or life-threatening condition
Symptoms that may occur with jaundice can be caused by life-threatening conditions, such as liver failure, portal hypertension, or esophageal varices. Seek immediate medical care (call 911) if you, or someone you are with, have any of the following symptoms:
- Change in level of consciousness or alertness such as passing out
- Change in mental status or sudden behavior change such as confusion
- Difficulty breathing or shortness of breath
- Muscle tremors or shakiness
- Severe weakness
- Sudden edema (swelling) in the legs
- Swelling of the abdomen (due to a buildup of fluid, or ascites)
Seek immediate medical care (call 911) if your baby has any of the following symptoms, which may accompany jaundice:
- Extreme fussiness
- Inability to be woken easily
- Lack of stool or urine
- Serious feeding problems or inability to breastfeed or bottle feed
- Unusually weak, stiff or floppy body
What causes jaundice?
Normally, the body continuously replaces older red blood cells with new ones. Hemolysis is the event where dying or diseased red blood cells release hemoglobin, which the liver processes into the yellow pigment, bilirubin. The liver further processes bilirubin and expels it from the body in a substance called bile. (Bile also contains substances to help digestion.) Bile flows through the bile duct into the small intestine to aid in digestion. It eventually mixes with stool for elimination.
Jaundice occurs when an underlying disease, disorder or condition lets excess bilirubin accumulate in the body. The causes vary between newborn infants and adults and older children.
Causes of newborn jaundice
Jaundice is common in newborns due to a condition called physiological jaundice. It is usually not serious and often disappears within two weeks after birth. A pregnant woman’s liver processes the bilirubin produced in the fetus before birth. After birth, the baby’s liver begins to function and process bilirubin. But the baby’s liver may not process bilirubin in enough quantity during the first few days. This can result in temporary yellowing of the eyes and skin that is often not serious or harmful. Breastfeeding can also cause newborn jaundice.
Serious, but less common, causes of newborn jaundice include:
- Biliary atresia (blockages in the ducts carrying bile from the liver to the gallbladder)
- Certain blood disorders or abnormalities
- Certain inherited disorders
Although jaundice in newborns is often not serious, your infant’s healthcare provider needs to know immediately about any yellowing of the eyes or skin. To be safe, the doctor may need to monitor and treat the jaundice.
Causes of jaundice in children and adults
Jaundice occurs in children and adults when bilirubin builds up due to serious diseases and conditions that cause liver damage or dysfunction, or block the bile ducts. Pancreatitis and gallstones can also cause obstruction of the bile ducts and jaundice.
Liver or biliary-system causes of jaundice include:
- Bile duct narrowing or obstruction (due to gallstones or pancreatitis)
- Cancer including that of the liver and pancreas
- Cirrhosis (liver scarring due to a variety of liver diseases)
- Drug-induced cholestasis (slowing of bile flow due to medications)
- Hepatitis (liver inflammation, which can be caused by alcoholism, medications or infection)
- Ischemic hepatocellular jaundice (due to a lack of blood or oxygen reaching the liver)
- Malaria (disease in which parasites destroy red blood cells)
- Pregnancy-induced obstruction of the bile ducts
Other causes of jaundice include:
- Hemolytic anemia (condition in which the body destroys too many of its own red blood cells)
- Sickle cell anemia (inherited disease characterized by abnormally shaped red blood cells)
What are the risk factors for jaundice?
A number of factors increase the risk of developing jaundice. Not all newborns or people with risk factors will get jaundice.
Risk factors for jaundice in newborns
Infant jaundice is very common, affecting about 60% of newborns. In most cases, it is mild and temporary. However, certain factors increase the risk of jaundice, which can lead to complications when it is severe. Risk factors include:
- Birth trauma: Bruising can occur during delivery. Bruises are collections of blood in the skin that occur when small blood vessels break. They are a source of extra blood cells that the body needs to break down into bilirubin.
- Blood type incompatibility: Sometimes, ABO or Rh mismatches between moms and babies can result in hemolytic disease. It causes an abnormally high breakdown of red blood cells in the baby.
- Breastfeeding: The reason for this is unclear. It may be related to feeding problems, which tend to be more common as infants learn to breastfeed. This can lead to inadequate nutrition and dehydration. Despite this, the benefits of breastfeeding typically outweigh the risk of jaundice.
- Genetics: The risk is higher in males and those with a sibling who also had jaundice.
- Prematurity: About 80% of babies born before 38 weeks of gestation will develop jaundice in the days after birth. Their livers are less developed than full-term babies and they have fewer bowel movements. This results in more bilirubin building up in the body.
- Race: Babies with Eastern Asian or Native American ethnicity have a higher risk of jaundice.
There are also maternal factors that can increase the risk of infant jaundice. This includes having diabetes and the use of diazepam (Valium) or oxytocin (Pitocin).
Reducing the risk of jaundice in newborns
Unfortunately, most of the risk factors for newborn jaundice are beyond your control. You may be able to lower the risk of infant jaundice by:
- Checking the mother’s blood type early in pregnancy
- Making sure breastfed infants get enough fluids to stay hydrated
- Treating maternal medical conditions, including diabetes and high blood pressure, to prevent premature birth
Regular prenatal care, starting at the first sign of pregnancy, is vital for the health of your baby. It can’t guarantee that problems like prematurity won’t happen. But it offers you and your baby the best chance for a safe pregnancy and delivery.
Risk factors for jaundice in children and adults
Risk factors for jaundice in children and adults are related to risk factors for liver and gallbladder disease. Risk factors include:
- Alcoholism or heavy alcohol use
- Exposure to hepatitis A, hepatitis B, hepatitis C, or Epstein-Barr viruses
- Family history of jaundice, liver disease, or gallstones
- Illicit and injection drug use
- Use of medications that can damage the liver, such as acetaminophen (Tylenol) or anabolic steroids
Reducing your risk of jaundice
You may be able to lower your risk of jaundice by:
- Following labeling instructions and warnings for prescription and over-the-counter drugs
- Getting hepatitis vaccinations
- Limiting alcohol use and seeking care for alcohol dependency
- Not using illicit or injection drugs, not sharing equipment, and getting help for addictions
- Practicing safe sex
If you have risk factors for jaundice, talk with your doctor. Find out specific ways you can reduce the risk of developing jaundice. Regular medical care can help prevent problems and identify issues early.
How do doctors diagnose jaundice?
The yellow color of jaundice is obvious and doctors can usually see right away that it’s a problem. The challenge is finding out why it is occurring.
Diagnosing jaundice in newborns
Looking at your baby is probably enough to know if jaundice is present. But it’s important to find out how much bilirubin is in the blood. This will tell the doctor how severe the jaundice is and help guide treatment. Tests to measure the amount of bilirubin include:
- Blood test to measure bilirubin directly
- Skin test with a transcutaneous bilirubinometer
The doctor may order additional tests and exams if an underlying medical condition could be the problem.
Diagnosing jaundice in children and adults
To diagnose the underlying cause of adult jaundice, your doctor may ask several questions including:
- How long have you noticed jaundice?
- Do you have dark urine? When did it start?
- Do you have a personal or family history of liver or gallbladder disease?
- What other medical conditions do you have?
- What medications do you take?
Your doctor may also review risk factors for viral hepatitis and perform a physical exam. The exam will include a focus on the abdomen, feeling for tenderness or enlarged organs.
Along with your medical history and physical exam, your doctor may order tests including:
- Blood tests, which may include liver function tests, complete blood count, clotting tests, blood cultures, and microscopic examination of the cells
- Imaging exams, which may include ultrasound, CT (computed tomography), or MRI (magnetic resonance imaging)
In some cases, doctors recommend a liver biopsy to take a sample of tissue.
How is jaundice treated?
The goals of jaundice treatment are to reduce bilirubin levels and relieve symptoms, such as itching. For both adults and infants, this doesn’t always require treatment. Bilirubin levels may gradually return to normal on their own. However, sometimes treatment is necessary.
Treating jaundice in newborns
When infant jaundice is mild and there is no underlying condition, it usually clears within a few weeks. It’s a function of the baby’s liver maturing and catching up on ridding the body of bilirubin. Moderate to severe jaundice requires treatment to avoid complications. Treatment depends on why doctors think the jaundice is happening. Treatments may include:
- Fluid and nutrition therapy for breastfed babies who need it
- IVIG (intravenous immunoglobulin) for blood type incompatibilities
- Phototherapy, or light therapy, either at home or in the hospital. This involves putting the baby under a special blue light, which helps break down bilirubin in the skin. Your baby will wear a diaper to expose as much skin as possible and eye coverings to protect the eyes. Light-emitting blankets, pads and mattresses are also available.
In severe cases that do not respond to other treatments, exchange transfusion may be necessary. This involves replacing the baby’s blood with fresh blood. Doctors repeatedly draw out small amounts of blood and infuse donor blood. This dilutes the bilirubin.
Treating jaundice in children and adults
In adults and children, treating the underlying cause of jaundice is the way to resolve it. The specific treatment will vary with the cause. Itching will gradually subside as the liver recovers. When itching is a problem, doctors may prescribe cholestyramine (Questran). Cholestyramine is a bile acid sequestrant or resin. It binds to bile and helps the body get rid of it faster.
What are the potential complications of jaundice?
Complications of jaundice vary depending on the underlying disease, disorder or condition. Jaundice is an important signal that something abnormal is happening inside the body. Jaundice in adults is often due to serious conditions, such as liver disease, that can lead to serious and life-threatening complications including:
- Esophageal varices
- Hepatic encephalopathy
- Portal hypertension, which can lead to gastrointestinal bleeding
Complications of jaundice in newborns
In newborns, very high or rapidly rising levels of bilirubin, which cause jaundice, can lead to a rare but serious complication called kernicterus, a type of brain damage. Kernicterus can lead to the following conditions:
- Cerebral palsy
- Hearing loss
- Teeth and vision problems
You can help minimize your risk of serious complications by seeking regular medical care and following the treatment plan you and your health care professional design specifically for you or your child.