Jaundice is the yellow color seen in the skin of many newborns. Jaundice results when a chemical called bilirubin builds up in the baby’s blood. Too much bilirubin can cause hyperbilirubinemia. It is the most frequent reason for hospital readmission during the first week of a baby’s life.

Kernicterus is a type of brain damage that causes athetoid cerebral palsy and hearing loss. It also causes problems with vision and teeth and sometimes can cause mental retardation. Any baby with untreated jaundice is at risk for kernicterus. This does not mean that every baby with yellow skin will have brain damage. Most babies with jaundice get better by themselves. If their skin is very yellow, they might need phototherapy treatment. If phototherapy does not lower the baby's bilirubin levels, the baby may need an exchange transfusion. 

Causes

Jaundice can develop when red blood cells break down and bilirubin is left. It is normal for some red blood cells to die every day. In the womb, the mother’s liver removes bilirubin for the baby, but after birth the baby’s liver must remove the bilirubin. In some babies, the liver might not be developed enough to efficiently get rid of bilirubin. When too much bilirubin builds up in a new baby’s body, the skin and whites of the eyes might look yellow. This yellow coloring is called jaundice.

Risk Factors

Jaundice within the first 24 hours after birth
A sibling who received phototherapy as a newborn
Unrecognized hemolysis such as ABO blood type incompatibility or Rh incompatibility
Non-optimal sucking/nursing or exclusive breastfeeding
Deficiency in glucose-6-phosphate dehydrogenase (G6PD)
Infant born early, especially late preterm births (34-37 weeks)
Cephalohematomas/bruising
East-Asian or Mediterranean descent

Symptoms

Jaundice usually appears first on the face and then moves to the chest, belly, arms, and legs as bilirubin levels get higher. The whites of the eyes can also look yellow. Jaundice can be harder to see in babies with darker skin color. Your baby’s doctor or nurse can test how much bilirubin is in your baby’s blood.

As for Kernicterus, watch for the following symtpoms:

• very yellow or orange (skin color changes start from the head and spread to the toes)

• hard to wake up or will not sleep at all

• not breastfeeding or sucking from a bottle well

• very fussy

• does not have at least 4 wet or dirty diapers in 24 hours

Diagnosis

Diagnosis is done by a doctor.

Treatment

No baby should develop brain damage from untreated jaundice. If a baby gets too jaundiced, the baby can be treated with phototherapy. That is, the baby can be put under blue lights most of the day. The blue lights do not bother the baby. They are warm and probably feel good. If the baby gets very, very jaundiced, the doctor can do an exchange transfusion. 

References

CDC