Jaundice: Causes, Symptoms, Diagnosis and Treatment

Jaundice is a condition that causes the skin and the whites of the eyes to turn yellow, according to the Centers for Disease Control and Prevention (CDC).

It occurs when a yellow substance called bilirubin builds up in the blood. Bilirubin forms when hemoglobin (the protein in red blood cells that transports oxygen) is broken down, per the Merck Manual.right up arrow It binds with bile in the liver and moves into the digestive tract, where it is mostly eliminated in stool. (A small amount is eliminated in urine.) However, if bilirubin cannot travel through the liver and bile ducts quickly enough, it accumulates in the blood and is deposited in the skin, eyes, and other tissues, which leads to jaundice.
Jaundice is common in newborns. When babies have jaundice, it usually goes away on its own, but in some cases, it can become severe and cause bigger issues. It can also occur in adults from specific disease.

Jaundice

Signs and Symptoms of Jaundice

Infants

Typically, the telltale yellow or orange coloring of jaundice first appears on a baby's face, then it migrates down the body to the chest, abdomen, arms, and legs, notes the CDC.right up arrow The whites of the eyes can also take on a yellowish hue. Signs in babies that warrant a same-day visit to the doctor include:

• Very yellow or orange skin color
• Extreme fussiness
• Difficulty waking up
• Not sleeping
• Poor feeding
• Limited wet or dirty diapers

If your baby exhibits any of the following symptoms, seek emergency medical assistance:

• Inconsolable or high-pitched crying
• Arching their body like a bow
• Stiff, limp, or floppy body
• Unusual eye movements

Adults

Certain adults are also susceptible to jaundice, according to the Cleveland Clinic.right up arrow While some don’t exhibit any symptoms, for others, signs may include:

• Change in skin color
• Flu-like symptoms, like fever and chills
• Dark urine
• Clay-colored stool
• Itchy skin
• Weight loss
• Per the Merck Manual, other signs of jaundice in adults include:right up arrow
• Blood in vomit or stool
• Tarry black stool
• Extreme abdominal pain and tenderness
• Sudden drowsiness, agitation, or confusion
• Easy bruising or bleeding, sometimes causing a rash of tiny reddish-purple dots or larger splotches

Causes and Risk Factors of Jaundice

Infants

There are a few different reasons babies might get jaundice. They include:

Physiologic Jaundice During pregnancy, the mother’s liver is tasked with removing the baby’s bilirubin. Once the baby is born, their liver takes over. But when the baby's liver isn’t developed enough to handle the bilirubin, buildup and the resulting jaundice occurs, notes the CDC.right up arrow This is the most common explanation for jaundice in newborns, and it’s usually nothing to worry about.
Suboptimal Intake Jaundice Also dubbed breastfeeding jaundice, this tends to occur during the baby's first week, when they may not be receiving an optimal amount of breast milk. Because of this, there’s an uptick in bilirubin reabsorption in the intestines and that leads to elevated bilirubin levels in the blood. At the same time, not consuming enough breast milk can delay the passage of bilirubin-rich meconium, or baby’s first stool. That initial bowel movement is an important way to usher bilirubin out of the body, notes the CDC.right up arrow
Breast Milk Jaundice This type of jaundice generally occurs in the baby’s second or later week of life. While it’s unclear the exact reason for breast milk jaundice, it’s thought that substances in the breast milk may hinder baby’s liver from properly processing bilirubin.

Blood Type If a mother and baby have different (incompatible) blood types, the mother's body makes antibodies that attack the baby's red blood cells, making the baby more likely to get jaundice, according to KidsHealth.right up arrow
This occurs when the mother's blood type is O and the baby's blood type is A or B or the mother's Rh factor (a protein found on red blood cells) is negative and the baby is Rh positive.

Glucose-6-Phosphate Dehydrogenase Deficiency An enzyme called G6PD (glucose-6-phosphate dehydrogenase) helps red blood cells function. With a G6PD deficiency, the baby’s red blood cells either don’t make enough G6PD or what’s made simply doesn't work, which causes red blood cells to break apart, triggering jaundice, says KidsHealth.right up arrow
G6PD deficiency is most common in males of African heritage.

“Infants of Mediterranean descent may also be at increased risk for G6PD deficiency,” explains David L. Hill, MD, adjunct assistant professor of pediatrics at the University of North Carolina School of Medicine in Chapel Hill. “But as long as doctors follow standard bilirubin monitoring guidelines, these issues shouldn’t overly concern parents.”

Other Underlying Disorders Here, jaundice can surface either earlier or much later than the more prevalent forms of newborn jaundice, per the Mayo Clinic.right up arrow Some of the conditions that may cause jaundice include:

• Internal bleeding
• Blood infection (sepsis)
• Viral or bacterial infections
• Blocked or scarred bile ducts
• Red blood cell abnormality
• A condition that affects the liver, like cystic fibrosis, according to the March of Dimes

Risk Factors

While jaundice is very common, there are several factors that can elevate a baby’s chance of getting the condition, including:

Being Born Before 37 Weeks There’s a higher probability that a preterm baby’s liver won’t be fully developed, which means it may not be able to process and pass enough bilirubin.right up arrow
Sibling With Jaundice If you have one child that developed jaundice as a baby, there’s a higher chance that your other children will get jaundice as well.

Bruised at Birth A baby born with bruises is more likely to get jaundice, because when large bruises heal, they can cause high levels of bilirubin.right up arrow

Adults

Jaundice in adults is usually brought on by reactions to drugs or underlying disorders that damage the liver, interfere with the flow of bile, or trigger the destruction of red blood cells, according to the Merck Manual.right up arrow
Per the Cleveland Clinic, causes of jaundice in adults include, but not limited to:right up arrow
Reabsorption of a large hematoma (a collection of clotted blood underneath the skin)
Hemolytic anemias, where blood cells are prematurely destroyed and removed from the bloodstream
Medications, including acetaminophen, penicillin, oral contraceptives, chlorpromazine (Thorazine), and estrogenic or anabolic steroids
Viruses, including hepatitis A, chronic hepatitis B and C, and Epstein-Barr

• Autoimmune Disorders
• Alcohol overuse leading to hepatitis
• Rare genetic metabolic defects
• Gallstones
• Inflammation of the gallbladder
• Gallbladder cancer
• Pancreatic cancer

Nonalcoholic fatty liver disease from risk factors including diabetes and obesity
Hereditary disorders that interfere with how the body processes bilirubin, such as Gilbert syndrome and Dubin-Johnson syndrome, can also cause jaundice, but this is less common, according to the Merck Manual.right up arrow
How Is Jaundice Diagnosed?
Infants
The CDC asserts that newborns should be checked for jaundice at least every 8 to 12 hours in the first 48 hours of life and then again before 5 days old.right up arrow

Testing options include:

Light Meter Here, a light meter is placed on a baby’s head to check the transcutaneous bilirubin (TcB) level.

Blood Test The baby’s total serum bilirubin (TSB) level is tested after a small blood sample is taken from baby’s heel. According to the CDC, this is the best way to accurately measure bilirubin levels in an infant.

Adults

For adults, the yellowing of jaundice may be easy to spot, but zeroing in on the underlying cause requires a physical exam. According to the Merck Manual, further testing may include:right up arrow
Blood Tests Various blood tests may be utilized, including a complete blood count, blood cultures, liver enzyme tests, and hepatitis tests.
Imaging Tests Ultrasonography of the abdomen is often used to detect blockages in bile ducts. A computerized tomography (CT) scan, magnetic resonance imaging (MRI), or other tests to evaluate the flow of bile through the liver may also be used.
Liver Biopsy If viral hepatitis, drug use, or exposure to a toxin are suspected (or if a diagnosis is unclear), a biopsy may be required.
Endoscopic Retrograde Cholangiopancreatography (ERCP)ERCP is a procedure that looks at the bile ducts through an endoscope, according to MedlinePlus.right up arrow
Laparoscopy (Rarely) Here, your doctor makes a small incision below the navel and inserts a tube fitted with a camera (laparoscope) to examine the liver and gallbladder. (If a larger incision is required, this procedure is then called a laparotomy.)

Prognosis of Jaundice

Newborn jaundice is not harmful in most cases, and usually gets better without treatment, notes MedlinePlus.right up arrow
Jaundice typically doesn’t require treatment in adults. However, its causes and complications are the focus of treatment and management, per the Cleveland Clinic.

Duration of Jaundice

It’s fairly common for jaundice to last about one month in breastfed babies. For formula-fed infants, jaundice usually subsides by two weeks, according to HealthyChildren.org.right up arrow
In adults, the duration of your jaundice will depend on the underlying cause and will vary from short term to unresolvable. For example: If your jaundice has been triggered by an infection, your symptoms will likely get better when your infection clears up, notes American Family Physician.right up arrow If you are taking medication that has caused your jaundice, it will likely go away when you stop taking the medicine. If you have gallstones, your jaundice should disappear after your gallbladder is removed. If you have long-term liver disease, such as chronic hepatitis or untreatable hepatobiliary cancers, your jaundice may not improve.

Treatment and Medication Options for Jaundice

Infants

Treatment and medication options for jaundice differ for infants and adults. According to the Mayo Clinic, if a baby has moderate or severe jaundice, the following treatment options may come into play:right up arrow
Additional Feeding Your doctor may advise more frequent feedings or supplementation.
Phototherapy Here, the baby is undressed down to a diaper and put under special blue-green lights that help break down bilirubin in the skin so that it can be excreted.
Blood Protein Transfusion When baby’s jaundice is related to blood type incompatibility with mom, an IV transfusion of immunoglobulin (IVIg) may be required. Immunoglobulin is a blood protein that can reduce the level of antibodies that are contributing to the breakdown of baby's red blood cells.
Exchange Transfusion On rare occasions when severe jaundice doesn’t respond to earlier treatments, the baby may require what’s called an exchange transfusion of blood. Here, small amounts of blood are repeatedly withdrawn and then replaced with donor blood. This process helps dilute bilirubin and antibodies from the mother.

Adults

In adults, the underlying cause of the jaundice is treated, not the jaundice itself, notes the Merck Manual.right up arrow For example, if jaundice has been caused by acute viral hepatitis, it may clear up gradually as the liver improves. If the cause is a blocked bile duct, a procedure may be performed to open the bile duct.
Medication Options
Treatment focus is always on the underlying causes. Taking cholestyramine by mouth can relieve itchy skin caused by jaundice, yet many patients do not have itchy skin.

Alternative and Complementary Therapies

HealthyChildren.org notes that exposing baby to sunlight through a window may help lower the bilirubin level.right up arrow This, of course, only works if the baby is undressed. (Newborns should never be put in direct sunlight outdoors.)
There are some studies on herbal medicine used with and without phototherapy for neonatal jaundice, yet the results are not widely conclusive and more studies are needed in the United States.right up arrow Talk to your pediatrician before starting any complementary and alternative medicine (CAM) approach, especially with infants.

Prevention of Jaundice

Infants

The best way to prevent infant jaundice is to make sure they get enough feedings, according to the Mayo Clinic.right up arrow For the first few days of life, breastfeeding infants should have 8 to 12 feedings a day. Formula-fed infants typically should have 1 to 2 ounces of formula every two to three hours for the first week of life.
“Regular feeding can help bring the bilirubin level down, so be sure your newborn is going no longer than four hours between feeds,” says Dr. Hill.

Adults

Since there are numerous causes for jaundice in the adult population, there are no hard-and-fast preventive guidelines. With that, here are some helpful steps to take, according to the Cleveland Clinic.right up arrow
Avoid hepatitis infection
If you drink alcohol, drink in moderation, or stop if you have a history of hepatitis or liver injury
Avoid becoming overweight or obese
Keep your cholesterol levels healthy
Complications of Jaundice
Severe jaundice can lead to serious complications in babies, according to the CDC.right up arrow These include:
Kernicterus This condition, a type of brain damage, can occur in babies when severe jaundice goes too long without treatment. It can cause athetoid cerebral palsy and hearing loss, as well as issues with vision and teeth and sometimes intellectual disabilities.

Acute Bilirubin Encephalopathy This condition can occur when baby has a severe case of jaundice and bilirubin enters the brain (bilirubin is toxic to the brain). According to the Mayo Clinic, some signs of this condition include:

• Listlessness
• Trouble waking up
• High-pitched crying
• Poor feeding or sucking
• Arching the body like a bow
• Fever

Related Conditions and Causes of Jaundice

According to MedlinePlus, certain conditions an cause jaundice, including:right up arrow
Liver infections from a virus (hepatitis A, hepatitis B, hepatitis C, hepatitis D, and hepatitis E) or a parasite
Birth defects or disorders that makes it difficult for the body to break down bilirubin (such as Gilbert syndrome, Dubin-Johnson syndrome, Rotor syndrome, or Crigler-Najjar syndrome)

• Chronic liver disease
• Gallstones or gallbladder disorders
• Blood disorders
• Pancreatic cancer
• Bile buildup in the gallbladder due to pressure in the abdominal area during pregnancy