The diagnosis of jaundice in their newborn baby is often very frightening to new parents. They immediately begin to think something is very wrong with their infant, and may not be fully informed about the facts, which are actually very reassuring.

It Is Very Common
Because jaundice is such a common condition, some medical professionals don't take the time to explain all the details, because they deal with jaundiced babies every day. However, when the baby in question is your own precious newborn, you need to get as much information as possible to put your mind at ease. Nearly all infants are jaundiced to some degree. In the vast majority of cases, newborn jaundice is a normal process, which many researchers feel may even serve protective functions, such as guarding the infant from the effects of oxygen free radicals. It makes sense that something that occurs in the majority of babies so routinely may be part of nature's plan for the human infant. Jaundice occurs when a yellow pigment called "bilirubin" accumulates in the tissue, especially the skin, where you can see it as a yellowish or orangish tint. In adults or older children, jaundice is considered a pathological condition, but this is rarely the case with newborns. The very common type of jaundice that most babies experience is called normal, or "physiologic" jaundice. Physiologic jaundice is not a disease - it is nearly always a harmless condition with no adverse after effects, as long as the bilirubin count doesn't reach dangerous levels.

How Jaundice Occurs
Before babies are born, they need high levels of red blood cells in order to get oxygen from their mother's blood. Immediately after birth, when they begin breathing high-oxygen blood outside the womb, they no longer need their fetal hemoglobin. The red blood cells containing fetal hemoglobin now need to be broken down and eliminated from their bodies. Bilirubin is a by-product of the breakdown of these extra blood cells, and is removed from the bloodstream by the liver and excreted in the stool. It accumulates in the meconium (fetal stool - the black, tarry stuff that the baby excretes the first couple of days after birth) and if not excreted, can be re-absorbed into the baby's system. The newborn's immature liver may not be able to process and excrete the bilirubin fast enough in the first days after birth, so jaundice often develops. This is especially common in premature infants.

Bilirubin is measured in milligrams per deciliter of blood, or mg/dl. The average level for an adult is 1mg/dl. The average full-term newborn will have a peak level of 6mg/dl on the third or fourth day of life. Levels usually go down to about 2 to 3mg/dl by the end of the first week, gradually reaching the adult value of 1mg/dl by the end of the second week. It usually takes the newborn's liver a week or two to mature enough to handle the build-up of bilirubin in the blood. It is important to know that there is no evidence that bilirubin levels of less than 20mg/dl during the first week of life, and less than 25mg/sl after that have any harmful effects of healthy, full-term babies.

So, if jaundice is such a normal condition, why all the concern? Because there are rare medical conditions which cause bilirubin to rise to dangerous levels, and can cause brain damage. Years ago, before we had the diagnostic tools and treatment options that we have today, some babies with very high bilirubin levels suffered from a condition called bilirubin encephalopathy, or kernicterus. This is rarely seen today, and then usually only in very premature or sick babies. Doctors today monitor bilirubin levels very carefully, and initiate treatment well before levels get high enough to cause problems.

There are three types of jaundice: Normal, or physiologic jaundice, affecting the majority of newborns; pathologic jaundice, caused by medical conditions such as blood type incompatibilities (the most common cause), as well as prematurity, infection, liver damage from rubella, syphllis or toxoplasmosis, and metabolic problems such as hypothyroidism; and late-onset, or breastmilk jaundice (probably caused by a factor in some mothers' milk that seems to delay or prolong the excretion of excess bilirubin).

It is important to understand the different types of jaundice, because each has different causes, consequences and treatments.