Overview

What is Jaundice?

It’s a disease that turns your skin and the whites of your eyes yellow. Newborn babies often get it. But adults can, too.

Jaundice is a condition in which the skin, sclera (whites of the eyes), and mucous membranes turn yellow. This yellow color is caused by a high level of Bilirubin, a yellow-orange bile pigment. Bile is fluid secreted by the liver. Bilirubin is formed from the breakdown of red blood cells.

“Jaundice” is the medical term that describes yellowing of the skin and eyes. Jaundice itself is not a disease, but it is a symptom of several possible underlying illnesses. Jaundice forms when there is too much bilirubin in your system. Bilirubin is a yellow pigment that is created by the breakdown of dead red blood cells in the liver. Normally, the liver gets rid of bilirubin along with old red blood cells.

Jaundice is a condition in which the skin, whites of the eyes and mucous membranes turn yellow because of a high level of bilirubin, a yellow-orange bile pigment. Jaundice has many causes, including hepatitis, gallstones and tumors. In adults, jaundice usually doesn’t need to be treated.

“Icteric” redirects here. For the physiological event, see Ictal. For the songbird Icteria, see Yellow-

Jaundice, also known as icterus, is a yellowish or greenish pigmentation of the skin and whites of the eyes due to high bilirubin levels. Jaundice in adults is typically a sign indicating the presence of underlying diseases involving abnormal heme metabolism, liver dysfunction, or biliary-tract obstruction. The prevalence of jaundice in adults is rare, while jaundice in babies is common, with an estimated 80% affected during their first week of life. The most commonly associated symptoms of jaundice are itchiness, pale feces, and dark urine.

Normal levels of bilirubin in blood are below 1.0 mg/dl (17 μmol/L), while levels over 2–3 mg/dl (34-51 μmol/L) typically result in jaundice. High blood bilirubin is divided into two types – unconjugated and conjugated bilirubin.

Jaundice is a term used to describe a yellowish tinge to the skin and the whites of the eye. Body fluids may also be yellow.

The color of the skin and whites of the eyes will vary depending on levels of bilirubin. Bilirubin is a waste material found in the blood. Moderate levels lead to a yellow color, while very high levels will appear brown. 

About 60 percent Trusted Source of all infants born in the United States have jaundice. However, jaundice can happen to people of all ages and is normally the result of an underlying condition. Jaundice normally indicates a problem with the liver or bile duct.

Infant jaundice is a common condition, particularly in babies born before 38 weeks’ gestation (preterm babies) and some breast-fed babies. Infant jaundice usually occurs because a baby’s liver isn’t mature enough to get rid of bilirubin in the bloodstream. In some babies, an underlying disease may cause infant jaundice.

Most infants born between 35 weeks’ gestation and full term need no treatment for jaundice. Rarely, an unusually high blood level of bilirubin can place a newborn at risk of brain damage, particularly in the presence of certain risk factors for severe jaundice.

Jaundice may indicate a serious problem with the function of your red blood cells, liver, gallbladder, or pancreas

What’s newborn jaundice?

Newborn jaundice is a yellowing of a baby’s skin and eyes. Newborn jaundice is very common and can occur when babies have a high level of bilirubin, a yellow pigment produced during noccrmal breakdown of red blood cells.

In older babies and adults, the liver processes bilirubin, which then passes it through the intestinal tract. However, a newborn’s still-developing liver may not be mature enough to remove bilirubin.

The good news is that in most cases, newborn jaundice goes away on its own as a baby’s liver develops and as the baby begins to feed, which helps bilirubin pass through the body.

In most cases, jaundice will disappear within 2 to 3 weeks. Jaundice that persists longer than 3 weeks may be a symptom of an underlying condition.

Additionally, high levels of bilirubin can put a baby at risk for deafness, cerebral palsy, or other forms of brain damage.

The American Academy of Pediatrics (AAP) recommends that all newborn babies be examined for jaundice before discharge from the hospital and again when the baby is between 3 and 5 days old.

See a doctor right away if you think you have jaundice. It could be a symptom of a liver, blood, or gallbladder problem.

Causes

What causes jaundice?

Jaundice is a yellowing of the skin and the whites of eyes that happens when the body does not process bilirubin properly. This may be due to a problem in the liver.

It is also known as icterus.

Bilirubin is a yellow-colored waste material that remains in the bloodstream after iron is removed from the blood.

The liver filters waste out from the blood. When bilirubin reaches the liver, other chemicals attach to it. A substance called conjugated bilirubin results.

The liver produces bile, a digestive juice. Conjugated bilirubin enters the bile, then it leaves the body. It is this type of bilirubin that gives feces its brown color.

If there is too much bilirubin, it can leak into the surrounding tissues. This is known as hyperbilirubinemia, and it causes the yellow color in the skin and eyes.

Jaundice can be caused by a problem in any of the three phases in bilirubin production.

Before the production of bilirubin, you may have what’s called unconjugated jaundice due to increased levels of bilirubin caused by:

• Reabsorption of a large hematoma (a collection of clotted or partially clotted blood under the skin).
• Hemolytic anemias (blood cells are destroyed and removed from the bloodstream before their normal lifespan is over).

During production of bilirubin, jaundice can be caused by:

• Viruses, including Hepatitis A, chronic Hepatitis B and C, and Epstein-Barr virus infection (infectious mononucleosis).
• Alcohol.
• Autoimmune disorders.
• Rare genetic metabolic defects.
• Medicines, including acetaminophen toxicity, penicillins, oral contraceptives, chlorpromazine (Thorazine®) and estrogenic or anabolic steroids.

After bilirubin is produced, jaundice may be caused by obstruction (blockage) of the bile ducts from:

• Gallstones.
• Inflammation (swelling) of the gallbladder.
• Gallbladder cancer.
• Pancreatic tumor.

Other Causes

Jaundice is a sign indicating the presence of an underlying diseases involving abnormal bilirubin metabolism, liver dysfunction, or biliary-tract obstruction. In general, jaundice is present when blood levels of bilirubin exceed 3 mg/dl.

Jaundice is classified into three categories, depending on which part of the physiological mechanism the pathology affects. The three categories are:

An underlying disorder may cause infant jaundice. In these cases, jaundice often appears much earlier or much later than does the more common form of infant jaundice. Diseases or conditions that can cause jaundice include:

• Internal bleeding (hemorrhage)
• An infection in your baby’s blood (sepsis)
• Other viral or bacterial infections
• An incompatibility between the mother’s blood and the baby’s blood
• A liver malfunction
• Biliary atresia, a condition in which the baby’s bile ducts are blocked or scarred
• An enzyme deficiency
• An abnormality of your baby’s red blood cells that causes them to break down rapidly

Prehepatic causes

Prehepatic jaundice is most commonly caused by a pathological increased rate of red blood cell (erythrocyte) hemolysis. The increased breakdown of erythrocytes → increased unconjugated serum bilirubin → increased deposition of unconjugated bilirubin into mucosal tissue. These diseases may cause jaundice due to increased erythrocyte hemolysis:[citation needed]

• Sickle-cell anemia
• Spherocytosis
• Thalassemia
• Pyruvate kinase deficiency
• Glucose-6-phosphate dehydrogenase deficiency
• Microangiopathic hemolytic anemia
• Hemolytic-uremic syndrome
• Severe malaria (in endemic countries)

Hepatic causes

Microscopy of a biopsy of a cholestasis liver showing bilirubin pigment (brown pigment), H&E stain

Hepatic jaundice is caused by abnormal liver metabolism of bilirubin. The major causes of hepatic jaundice are significant damage to hepatocytes due to infectious, drug/medication-induced, autoimmune etiology, or less commonly, due to inheritable genetic diseases. The following is a partial list of hepatic causes to jaundice:[citation needed]

• Acute hepatitis
• Chronic hepatitis
• Hepatotoxicity
• Cirrhosis
• Drug-induced hepatitis
• Alcoholic liver disease
• Gilbert’s syndrome (found in about 5% of the population, results in induced mild jaundice)
• Crigler-Najjar syndrome, type I
• Crigler-Najjar syndrome, type II
• Leptospirosis

Posthepatic causes (Obstructive jaundice)

Posthepatic jaundice (obstructive jaundice), is caused by a blockage of bile ducts that transport bile-containing conjugated bilirubin out of the liver for excretion. This is a list of conditions that can cause posthepatic jaundice:

• Choledocholithiasis (common bile duct gallstones). It is the most common causes of obstructive jaundice.
• Pancreatic cancer of the pancreatic head
• Biliary tract strictures
• Biliary atresia
• Primary biliary cholangitis
• Cholestasis of pregnancy
• Acute Pancreatitis
• Chronic Pancreatitis
• Pancreatic pseudocysts
• Mirizzi’s syndrome
• Parasites (“liver flukes” of the Opisthorchiidae and Fasciolidae)

What causes newborn jaundice?

Babies at highest risk for developing newborn jaundice are:

• premature babies (babies born before 37 weeks’ gestation)
• babies who aren’t getting enough breast milk or formula, either because they’re having a hard time feeding or because their mother’s milk isn’t in yet
• babies whose blood type isn’t compatible with the blood type of their mother

A baby whose blood type isn’t compatible with that of their mother can develop a buildup of antibodies that can destroy their red blood cells and cause a sudden rise in bilirubin levels.

Other causes of newborn jaundice include:

• bruising at birth or other internal bleeding
• liver problems
• an infection
• an enzyme deficiency
• an abnormality in your baby’s red blood cells

What causes jaundice in adults?

Jaundice in adults is caused by various medical conditions that affect the normal metabolism or excretion of bilirubin. Bilirubin is mostly formed from the daily breakdown and destruction of red blood cells in the bloodstream, which release hemoglobin as they rupture.

The heme portion of this hemoglobin molecule is then converted into bilirubin, which is transported in the bloodstream to the liver for further metabolism and excretion. In the liver, the bilirubin is conjugated with glucuronic acid (made more water-soluble), and is excreted into the gallbladder (where it is stored), and then eventually passed into the intestines.

In the intestines, a portion of the bilirubin is excreted in the feces, while some are metabolized by the intestinal bacteria to urobilinogen and excreted in the urine.

Jaundice occurs if there is a dysfunction of the normal metabolism and/or excretion of bilirubin. This disruption in the metabolism or excretion of bilirubin can occur at various stages, and it is, therefore, useful to classify the different causes of jaundice based on where the dysfunction occurs.

The causes of jaundice are generally classified as pre-hepatic (the problem arises before secretion to the liver), hepatic (the problem arises within the liver), and post-hepatic (the problem arises after bilirubin is excreted from the liver).

Symptoms

What are the symptoms of jaundice?

The most common signs of jaundice in adults are a yellowish discoloration of the white area of the eye (sclera) and skin with scleral icterus presence indicating a serum bilirubin of at least 3 mg/dl. Other common signs include dark urine (bilirubinuria) and pale,(acholia) fatty stool (steatorrhea). Because bilirubin is a skin irritant, jaundice is commonly associated with severe itchiness.

Eye conjunctiva has a particularly high affinity for bilirubin deposition due to high elastin content. Slight increases in serum bilirubin can, therefore, be detected early on by observing the yellowing of sclerae. Traditionally referred to as scleral icterus, this term is actually a misnomer, because bilirubin deposition technically occurs in the conjunctival membranes overlying the avascular sclera. Thus, the proper term for the yellowing of “white of the eyes” is conjunctival icterus.

A much less common sign of jaundice specifically during childhood is yellowish or greenish teeth. In developing children, hyperbilirubinemia may cause a yellow or green discoloration of teeth due to bilirubin deposition during the process of tooth calcification.

While this may occur in children with hyperbilirubinemia, tooth discoloration due to hyperbilirubinemia is not observed in individuals with adult-onset liver disease. Disorders associated with a rise in serum levels of conjugated bilirubin during early development can also cause dental hypoplasia.

Sometimes, the person may not have symptoms of jaundice, and the condition may be found accidentally. The severity of symptoms depends on the underlying causes and how quickly or slowly the disease develops.

If you have a short-term case of jaundice (usually caused by infection), you may have the following symptoms and signs:

• Fever.
• Chills.
• Abdominal pain.
• Flu-like symptoms.
• Change in skin color.
• Dark-colored urine and/or clay-colored stool.

The common symptoms of jaundice usually include a yellowish or brownish-orange tinge of skin, eyes, body fluids like urine and stool. Other signs and symptoms due to the causative factors include:

• Nausea and vomiting
• Diarrhoea
• Fever and chills
• Loss of appetite
• Abdominal pain and discomfort
• General debility
• Headache
• Confusion
• Swelling of the legs and abdomen
• Weight Loss
• Skin Itching

If jaundice isn’t caused by an infection, you may have symptoms such as weight loss or itchy skin (pruritus). If the jaundice is caused by pancreatic or biliary tract cancers, the most common symptom is abdominal pain. Sometimes, you may have jaundice occurring with liver disease if you have:

• Chronic hepatitis or inflammation of the liver.
• Pyoderma gangrenosum (a type of skin disease).
• Acute hepatitis A, B or C.
• Polyarthralgias (inflammation of the joints).

What are the symptoms of newborn jaundice?

The first sign of jaundice is a yellowing of a baby’s skin and eyes. The yellowing may begin within 2 to 4 days after birth and may start in the face before spreading down across the body.

Bilirubin levels typically peak between 3 to 7 days after birth.

If a finger lightly pressed on a baby’s skin causes that area of skin to become yellow, it’s likely a sign of jaundice.

See your baby’s doctor the same day if your baby:

• Is very yellow or orange (skin color changes start from the head and spread to the toes).
• Is hard to wake up or will not sleep at all.
• Is not breastfeeding or sucking from a bottle well.
• Is very fussy.
• Does not have enough wet or dirty diapers (at least 4-6 thoroughly wet diapers in 24 hours and 3 to 4 stools per day by the fourth day).

Get emergency medical help if your baby:

• Is crying inconsolably or with a high pitch.
• Is arched like a bow (the head or neck and heels are bent backward and the body forward).
• Has a stiff, limp, or floppy body.
• Has strange eye movements.

When to call a doctor

Most cases of jaundice are normal, but sometimes jaundice can indicate an underlying medical condition. Severe jaundice also increases the risk of bilirubin passing into the brain, which can cause permanent brain damage.

Contact your doctor if you notice the following symptoms:

• Jaundice spreads or becomes more intense.
• Your baby develops a fever over 100°F (38°C).
• Your baby’s yellow coloring deepens.
• Your baby feeds poorly, appears listless or lethargic, and makes high-pitched cries.

Diagnosis

Most people presenting with jaundice have various predictable patterns of liver panel abnormalities, though significant variation does exist. The typical liver panel includes blood levels of enzymes found primarily from the liver, such as the aminotransferases (ALT, AST), and alkaline phosphatase (ALP); bilirubin (which causes the jaundice); and protein levels, specifically, total protein and albumin.

Other primary lab tests for liver function include gamma glutamyl trans peptidase (GGT) and prothrombin time (PT). No single test can differentiate between various classifications of jaundice. A combination of liver function tests and other physical examination findings is essential to arrive at a diagnosis.

Doctors will most likely use the history of the patient and a physical exam to diagnose jaundice and confirm bilirubin levels. They will pay close attention to the abdomen, feel for tumors, and check the firmness of the liver.

A firm liver indicates cirrhosis, or scarring of the liver. A rock-hard liver suggests cancer.

Several tests can confirm jaundice. The first is a liver function test to find out whether or not the liver is functioning properly.

If a doctor cannot find the cause, a doctor may request blood tests to check bilirubin levels and the composition of the blood. These include:

• Bilirubin tests: A high level of unconjugated bilirubin compared to levels of conjugated bilirubin suggest hemolytic jaundice.
• Full blood count (FBC), or complete blood count (CBC): This measures levels of red blood cells, white blood cells, and platelets.
• Hepatitis A, B, and C tests: This tests for a range of liver infections.

The doctor will examine the structure of the liver if they suspect an obstruction. In these cases, they will use imaging tests, including MRI, CT, and ultrasound scans. They may also carry out an endoscopic retrograde cholangiopancreatography(ERCP). This is a procedure combining endoscopy and X-ray imaging.

A liver biopsy can check for inflammation, cirrhosis, cancer, and fatty liver. This test involves inserting a needle into the liver to obtain a tissue sample. The sample is then examined under a microscope.

How is jaundice diagnosed?

Doctors diagnose jaundice by checking for signs of liver disease such as:

• Bruising of the skin.
• Spider angiomas (abnormal collection of blood vessels near the surface of the skin).
• Palmar erythema (red coloration of the palms and fingertips).

Urinalysis (urine testing) that’s positive for bilirubin shows that the patient has conjugated jaundice. The findings of urinalysis should be confirmed by serum testing. The serum testing will include a complete blood count (CBC) and bilirubin levels.

Your doctor will also do an exam to determine the size and tenderness of your liver. He or she may use imaging (ultrasonography and computer tomographic (CT) scanning) and liver biopsy (taking a sample of the liver) to further confirm the diagnosis.

The doctor may also perform a series of tests including:

• Liver blood tests like Bilirubin test, to measure the amount of bilirubin in your blood,
• Complete blood count (CBC)
• Blood tests to check lipase levels
• Electrolyte panel
• Urine test
• Other Liver tests
• Imaging techniques like ultrasound, CT scan, MRI, Cholescintigraphy, and Endoscopic retrograde cholangiopancreatography to analyse the condition of the liver and bile ducts.
• In certain chronic conditions, a biopsy is also done to check for cancerous cells.

How is newborn jaundice diagnosed?

The hospital discharges most mothers and newborns within 72 hours of delivery. It’s very important for parents to bring their babies in for a checkup a few days after birth because bilirubin levels peak between 3 to 7 days after birth.

A distinct yellow coloring confirms that a baby has jaundice, but additional tests may be needed to determine the severity of jaundice.

Babies who develop jaundice in the first 24 hours of life should have bilirubin levels measured immediately, either through a skin test or blood test.

Additional tests may be needed to see if a baby’s jaundice is due to an underlying condition. This may include testing your baby for their complete blood count (CBC), blood type, and Rhesus factor (Rh) incompatibility.

Additionally, a Coombs test may be done to check for increased red blood cell breakdown.

Types

There are three main types of jaundice:

• Hepatocellular jaundice occurs as a result of liver disease or injury.

• Hemolytic jaundice occurs as a result of hemolysis, or an accelerated breakdown of red blood cells, leading to an increase in the

  production of bilirubin.
• Obstructive jaundice occurs as a result of an obstruction in the bile duct. This prevents bilirubin from leaving the liver

Newborns

Jaundice is a common health issue in newborn infants. Around 60 percent of newborns experience jaundice, and this increases to 80 percent of premature infants born before 37 weeks of pregnancy.

They will normally show signs within 72 hours of birth.

Red blood cells in the body of an infant are frequently broken down and replaced. This causes the production of more bilirubin. Also, the livers of infants are less developed and, therefore, less effective at filtering bilirubin from the body.

Symptoms will usually resolve without treatment within 2 weeks. However, infants with extremely high bilirubin levels will require treatment with either a blood transfusion or phototherapy.

In these cases, treatment is vital as jaundice in newborns can lead to kernicterus, a very rare type of permanent brain damage.

Levels

The level of bilirubin is defined in a blood test called a bilirubin test. This measures unconjugated, or indirect, bilirubin levels. These are responsible for the onset of jaundice.

Bilirubin levels are measured in milligrams per decilitre (mg/dL). Adults and older children should have a level of between 0.3 and 0.6 mg/dL. Around 97 percent of infants born after 9 months of pregnancy have levels lower than 13 mg/dL. If they show higher levels than this, they are usually referred for further investigation.

These ranges may differ between laboratories. How far above the normal range a person’s levels are will set out a course of treatment.

Treatment

How is jaundice treated?

Jaundice usually doesn’t require treatment in adults (it’s a more severe problem in infants). The causes and complications of jaundice can be treated. For instance, if itching is bothersome, it may be eased by cholestyramine.

The following treatments are used:

• Anemia-induced jaundice may be treated by boosting the amount of iron in the blood by either taking iron supplements or eating more iron-rich foods. Iron supplements are available for purchase online.
• Hepatitis-induced jaundice requires antiviral or steroid medications.
• Doctors can treat obstruction-induced jaundice by surgically removing the obstruction.
• If jaundice has been caused by the use of a medication, treatment involves changing to an alternative medication.

What are some of the treatments of jaundice?

• Constipation.
• Bloating.
• Stomach pain.
• Gas.
• Upset stomach.
• Vomiting.
• Diarrhea.

How is newborn jaundice treated?

Mild jaundice will usually resolve on its own as a baby’s liver begins to mature. Frequent feedings (between 8 to 12 times a day) will help babies pass bilirubin through their bodies.

More severe jaundice may require other treatments. Phototherapy is a common and highly effective method of treatment that uses light to break down bilirubin in your baby’s body.

In phototherapy, your baby will be placed on a special bed under a blue spectrum light while wearing only a diaper and special protective goggles. A fiber-optic blanket may also be placed underneath your baby.

In very severe cases, an exchange transfusion may be necessary in which a baby receives small amounts of blood from a donor or a blood bank.

This replaces the baby’s damaged blood with healthy red blood cells. This also increases the baby’s red blood cell count and reduces bilirubin levels.

What is the treatment for jaundice in adults?

The treatment for jaundice depends entirely on the underlying cause. Once a diagnosis has been established, the appropriate course of treatment can then be initiated. Certain patients will require hospitalization, whereas others may be managed as outpatients at home.

• In certain individuals with jaundice, the treatment will consist of supportive care and can be managed at home. For example, most cases of mild viral hepatitis can be managed at home with watchful waiting and close monitoring by your doctor (expectant management). Novel medications for hepatitis C now can offer a cure for this condition.
• Alcohol cessation is necessary in patients with cirrhosis, alcoholic hepatitis, or acute pancreatitis secondary to alcohol use.
• Jaundice caused by drugs/medications/toxins requires discontinuation of the offending agent. In cases of intentional or unintentional acetaminophen (Tylenol) overdose, the antidote N-acetylcysteine (Mucomyst) may be required.
• Various medications may be used to treat the conditions leading to jaundice, such as steroids in the treatment of some autoimmune disorders. Certain patients with cirrhosis, for example, may require treatment with diuretics and lactulose.
• Antibiotics may be required for infectious causes of jaundice, or for the complications associated with certain conditions leading to jaundice (for example, cholangitis).
• Blood transfusions may be required in individuals with anemia from hemolysis or as a result of bleeding.
• Individuals with cancer leading to jaundice will require consultation with an oncologist, and the treatment will vary depending on the type and extent (staging) of cancer.
• Surgery and various invasive procedures may be required for certain patients with jaundice. For example, certain patients with gallstones may require surgery. Other individuals with liver failure/cirrhosis may require a liver transplant.

How Is Jaundice Treated?

Treatment depends on the cause of jaundice, the bilirubin levels, and a baby’s age.

Mild jaundice goes away after 1 or 2 weeks as a baby’s body gets rid of the extra bilirubin on its own. For newborns with breastfeeding jaundice, mothers should breastfeed the baby more often. If the baby is not getting enough breast milk, the doctor may suggest supplementing with formula.

For more serious cases of jaundice, treatment should start as soon as possible. Babies may get:

• fluids. A loss of fluids (dehydration) will cause bilirubin levels to rise.
• phototherapy. Babies lie under lights with little clothing so their skin is exposed. The light changes the bilirubin to a form that can easily pass out of the body. Light-therapy blankets may also be used.
• exchange blood transfusion. This emergency procedure is done if very high bilirubin levels do not come down with phototherapy. The baby’s blood is replaced with blood from a donor to quickly lower bilirubin levels.
• Intravenous immunoglobulin (IVIg). Babies with blood type incompatibilities get this through an IV (into a vein). IVIg blocks antibodies that attack red blood cells and reduces the need for an exchange transfusion.

Here’s how some of the conditions that cause jaundice might be treated:

• Alcohol-related cirrhosis or hepatitis: If alcoholic beverages are the cause of liver disease, stopping drinking is going to be crucial to resolving jaundice.

• Anemia: If hemolytic anemia, the lack of red blood cells caused by increased destruction, is the cause of jaundice, the treatment might include a blood transfusion.
• Cirrhosis: Cirrhosis is the end-stage of chronic liver disease and has many different causes. Treating jaundice from cirrhosis will depend on the type of liver disease present, but could include the use of corticosteroids or diuretics.
• Drug toxicities: In the case of a drug causing harm to the liver, the drug will need to be stopped (this includes prescription medications, over-the-counter drugs like acetaminophen, and illegal drugs). Another medication might need to be given to counteract the overdose.
• Gallstones: Gallstones that are resulting in jaundice might require treatment, which is typically the removal of the gallbladder.
• Liver cancer: Cancer of the liver will require treatment from a specialist and may include radiation and chemotherapy, as well as other medications for supportive therapy.
• Newborn jaundice: Newborn jaundice is common, and will often resolve on its own without any treatment. Some healthcare providers might recommend that newborns get some sunlight exposure to increase vitamin D production and clear the bilirubin. In other cases, a newborn might be given treatment in the hospital using special lights that can help resolve jaundice.
• Primary sclerosing cholangitis (PSC). This liver disease is associated with ulcerative colitis. Treatment is largely to manage symptoms, such as antibiotics and cholestyramine or diphenhydramine for itching. Surgery might be needed to open the bile ducts and place a stent to keep them open. A liver transplant is done in severe cases.

Treatment options for jaundice basically depend upon the causative factor i.e. the underlying conditions and complications related to it. In acute cases, the patient can get well with a few medications and rest at home. Other conditions may ask for treatment with intravenous fluids, antibiotics, and blood transfusions. In severe chronic conditions, the doctor may even call for surgery.

Prevention

Jaundice is related to liver function. It is essential that people maintain the health of this vital organ by eating a balanced diet, exercising regularly, and not consuming more than the recommended amounts of alcohol.

Can jaundice be prevented?

Since there are many causes of jaundice, it’s hard to provide specific prevention measures. Some general tips include:

• Avoid hepatitis infection.
• Stay within recommended alcohol limits.
• Maintain a healthy weight.
• Manage your cholesterol.

Can newborn jaundice be prevented?

There’s no real way to prevent newborn jaundice. During pregnancy, you can have your blood type tested.

After birth, your baby’s blood type will be tested, if necessary, to rule out the possibility of blood type incompatibility that can lead to newborn jaundice. If your baby does have jaundice, there are ways you can prevent it from becoming more severe:

• Make sure your baby is getting enough nutrition through breast milk. Feeding your baby 8 to 12 times a day for the first several days ensures that your baby isn’t dehydrated, which helps bilirubin pass through their body more quickly.
• If you’re not breastfeeding feeding your baby formula, give your baby 1 to 2 ounces of formula every 2 to 3 hours for the first week. Preterm or smaller babies may take smaller amounts of formula, as will babies who are also receiving breast milk. Talk to your doctor if you’re concerned your baby is taking too little or too much formula, or if they won’t wake to feed at least 8 times per 24 hours.

Carefully monitor your baby the first five days of life for the symptoms of jaundice, such as yellowing of the skin and eyes.

If you notice that your baby has the symptoms of jaundice, call your doctor immediately.

Risk factors

Jaundice most often happens as a result of an underlying disorder that either causes the production of too much bilirubin or prevents the liver from getting rid of it. Both of these result in bilirubin being deposited in tissues.

About 60% of all babies have jaundice. Some babies are more likely to have severe jaundice and higher bilirubin levels than others. Babies with any of the following risk factors need close monitoring and early jaundice manage­ment:

Underlying conditions that may cause jaundice to include:

Acute inflammation of the liver: This may impair the ability of the liver to conjugate and secrete bilirubin, resulting in a buildup.

Inflammation of the bile duct: This can prevent the secretion of bile and removal of bilirubin, causing jaundice.

Obstruction of the bile duct: This prevents the liver from disposing of bilirubin.

Hemolytic anemia: The production of bilirubin increases when large quantities of red blood cells are broken down.

Gilbert’s syndrome: This is an inherited condition that impairs the ability of enzymes to process the excretion of bile.

Cholestasis: This interrupts the flow of bile from the liver. The bile containing conjugated bilirubin remains in the liver instead of being excreted.

Rarer conditions that may cause jaundice to include:

Crigler-Najjar syndrome: This is an inherited condition that impairs the specific enzyme responsible for processing bilirubin.

Dubin-Johnson syndrome: This is an inherited form of chronic jaundice that prevents conjugated bilirubin from being secreted from of the cells of the liver.

Pseudojaundice: This is a harmless form of jaundice. The yellowing of the skin results from an excess of beta-carotene, not from an excess of bilirubin. Pseudojaundice usually arises from eating large quantities of carrot, pumpkin, or melon.

What is the risk you’ll develop jaundice?

During the production of bilirubin, middle-aged women and men, in general, are more affected. People who have hepatitis and drink excessive alcohol are also at increased risk.

Major risk factors for jaundice, particularly severe jaundice that can cause complications, include:

• Premature birth. A baby born before 38 weeks of gestation may not be able to process bilirubin as quickly as full-term babies do. Premature babies also may feed less and have fewer bowel movements, resulting in less bilirubin eliminated through stool.
• Significant bruising during birth. Newborns who become bruised during delivery gets bruises from the delivery may have higher levels of bilirubin from the breakdown of more red blood cells.
• Blood type. If the mother’s blood type is different from her baby’s, the baby may have received antibodies through the placenta that cause abnormally rapid breakdown of red blood cells.
• Breast-feeding. Breast-fed babies, particularly those who have difficulty nursing or getting enough nutrition from breast-feeding, are at higher risk of jaundice. Dehydration or a low caloric intake may contribute to the onset of jaundice. However, because of the benefits of breastfeeding, experts still recommend it. It’s important to make sure your baby gets enough to eat and is adequately hydrated.
• Race. Studies show that babies of East Asian ancestry have an increased risk of developing jaundice.

Complications

Hyperbilirubinemia, more precisely hyperbilirubinemia due to the unconjugated fraction, may cause bilirubin to accumulate in the grey matter of the central nervous system, potentially causing irreversible neurological damage, leading to a condition known as kernicterus. Depending on the level of exposure, the effects range from unnoticeable to severe brain damage and even death. Newborns are especially vulnerable to hyperbilirubinemia-induced neurological damage, so must be carefully monitored for alterations in their serum bilirubin levels.

What are the complications of jaundice in adults?

The type of complication and the severity of complications vary with the underlying cause leading to jaundice. Certain individuals will not suffer any long-term after effects and will have a full recovery, while for others the appearance of jaundice will be the first indication of a life-threatening condition. A few of the potential complications include:

• Electrolyte abnormalities
• Anemia
• Bleeding
• Infection/sepsis
• Chronic hepatitis
• Cancer & Liver failure
• Kidney failure
• Hepatic encephalopathy (brain dysfunction)
• Death

Individuals with parenchymal liver disease who have impaired hemostasis may develop bleeding problems.

Epidemiology

Jaundice in adults is rare. Under the five-year DISCOVERY program in the UK, the annual incidence of jaundice was 0.74 per 1000 individuals over age 45, although this rate may be slightly inflated due to the main goal of the program collecting and analyzing cancer data in the population. Jaundice is commonly associated with the severity of disease with an incidence of up to 40% of patients requiring intensive care in ICU experiencing jaundice. The causes of jaundice in the intensive care setting is both due to jaundice as the primary reason for ICU stay or as morbidity to an underlying disease (i.e. sepsis).

In the developed world, the most common causes of jaundice are blockage of the bile duct or medication-induced. In the developing world, the most common cause of jaundice is infectious such as viral hepatitis, leptospirosis, schistosomiasis, or malaria.

Summary

Jaundice causes your skin and the whites of your eyes to turn yellow. Too much bilirubin causes jaundice. Bilirubin is a yellow chemical in hemoglobin, the substance that carries oxygen in your red blood cells. As red blood cells break down, your body builds new cells to replace them. The old ones are processed by the liver. If the liver cannot handle the blood cells as they break down, bilirubin builds up in the body and your skin may look yellow.

Many healthy babies have some jaundice during the first week of life. It usually goes away. However, jaundice can happen at any age and maybe a sign of a problem. Jaundice can happen for many reasons, such as

• Blood diseases
• Genetic syndromes
• Liver diseases, such as hepatitis or cirrhosis
• Blockage of bile ducts
• Infections
• Medicines

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