Jaundice in Premature Babies

What You Should Know About Hyperbilirubinemia

A premature baby having light therapy.
A premature baby undergoing phototherapy to treat jaundice. BSIP/Universal Images Group/Getty Images

Jaundice is very common among newborns. Within a day or two of birth, around 60 percent of babies will develop the tell-tale yellow tinge to the skin and the whites of the eyes that indicate this typically temporary and benign condition. Jaundice is caused by hyperbilirubinemia—a complicated term with a simple meaning: elevated levels of bilirubin in the blood. It's easy to treat and rarely leads to other health problems. The only potential complication associated with jaundice in babies is a serious type of brain damage that's a risk if the condition isn't treated promptly and properly.

What can make jaundice potentially tricky for premature babies—those born before 35 weeks of gestation—is that they may be susceptible to this complication at lower levels of excess bilirubin than full-term babies. If you have a preemie with jaundice, your pediatrician will treat it with light therapy to make sure it resolves as soon as possible. Meanwhile, it should be comforting for you to understand the basics of jaundice and how it can affect a premature baby.

Symptoms and Complications

Jaundice is especially common in babies born before 35 weeks. In most cases, the only symptom of the condition is a yellowish tint affecting the skin and whites of the eyes. This occurs because bilirubin literally is yellow-orange in color.

If jaundice isn't treated promptly or properly, however, bilirubin can build up to dangerous levels. Untreated, excessively high levels of bilirubin can cause a severe form of brain damage known as kernicterus. Early symptoms of this condition include:

  • Persistent or worsening yellowing of the skin and eyes
  • Extreme fatigue
  • Difficulty waking up or sleeping
  • Problems feeding
  • Extreme fussiness, often accompanied by a high-pitch cry
  • Limpness or stiffness of the body
  • Unusual eye movements
  • Muscle spasms

If your baby experiences any of these symptoms, get emergency help immediately. Kernicterus can cause permanent neurological damage, including hearing loss, cerebral palsy, intellectual disabilities, and even death.

Causes and Risk Factors

Being premature increases a baby's risk of developing jaundice. According to kidshealth.org, 80 percent of premature infants have jaundice. Most babies who are born at term are able to metabolize bilirubin quite easily and pass it in their stools before too much accumulates. However, because a premature baby's liver isn't fully developed at birth, it may not fully metabolize bilirubin.

Fortunately, jaundice is so easy to diagnose that it rarely gets bad enough to cause kernicterus. Premature babies who are at risk will have their bilirubin levels closely monitored with either a blood test or forehead meter.

In addition to preterm birth, risk factors for hyperbilirubinemia include:

  • Having a sibling who was previously affected
  • Bruising during an instrumented delivery in which forceps or vacuum extraction is used to help with childbirth
  • Delay in passing the baby's first stool, called meconium

Treatment

The first-line treatment for jaundice is phototherapy, in which a newborn is exposed to special lights known as bili lights. The light literally helps the baby's body break down bilirubin into a form that can be easily excreted.

To treat a baby with phototherapy, he'll be undressed except for a diaper so that as much skin as possible can be exposed to the light and his eyes will be covered. He will lie in a warm bassinet or incubator—sometimes for several days—and his bilirubin levels will be measured at least once a day.

The light won't hurt your little one's skin at all. And if you're nursing, you can breastfeed as usual. In fact, you may need to feed him even more often, as phototherapy can be dehydrating.

In the unlikely case that phototherapy doesn't work to bring your baby's bilirubin levels to normal, your doctor may suggest a somewhat risky procedure called an exchange transfusion. For this procedure, some or all of a baby's blood is removed and replaced with donor blood. As you can imagine, there are many pros and cons to this approach, so you and the pediatrician will want to discuss all of them carefully.

A Word From Verywell

When a baby is born before term, he's at risk for many potential health problems, including jaundice. Although this condition can be more problematic for premature babies since the clearing of bilirubin depends on liver maturity and a preemie's organs often are well-developed, jaundice is easy to treat effectively. Whatever else you might be facing if you have a premature baby, rest assured jaundice is one that your child's medical team will be able to handle and eliminate quickly.

Sources:

Bhutani, VK, Wong, RJ. Hyperbilirubinemia in the Preterm Infant (Less Than 35 Weeks Gestation). UpToDate. Jan 17, 2018. www.uptodate.com/contents/hyperbilirubinemia-in-the-preterm-infant-less-than-35-weeks-gestation

Kidshealth.org. What is Prematurity?

Stokowski, LA. Fundamentals of Phototherapy for Neonatal Jaundice. Adv Neonatal Care. Oct, 2011:11(5 Suppl):S10-21. doi: 10.1097/ANC.0b013e31822ee62c. www.ncbi.nlm.nih.gov/pubmed/22123449

University of Wisconsin School of Medicine and Public Health. Phototherapy for Jaundice in Newborns. May 4, 2017.

Was this page helpful?
Article Sources
  • Okumura, A.; Kidokoro, H.; Shoji, H. et al. "Kernicterus in Preterm Infants." Pediatrics. 2009; 123, e1052-e1058. DOI: 10.1542/peds.2008-2791.
  • Punnoose, A.; Schwartz, L.; and Golub, R. "Neonatal Hyperbilirubinemia." JAMA. 2012; 307(19):2115. DOI: 10.1001/jama.2012.4070.