Newborn jaundice is the first problem that many new parents encounter after the birth of their baby. The baby turns from a pink blob of flesh to a yellow “little orange” at birth, which makes many new parents anxious and overwhelmed, wondering if their baby will have any major problems. Here, let’s take a look at what newborn jaundice is all about. Guangzhou United Family Hospital Pediatrics Department Liu Dihui Newborn babies often have mild or severe elevation of serum bilirubin due to the special characteristics of bilirubin metabolism, causing yellow skin staining, known as neonatal jaundice. This is a physiological phenomenon, if the degree of jaundice is not heavy, the duration is not long, and the general condition of the baby is good, it is a normal physiological phenomenon, that is, physiological jaundice of the newborn. Physiological jaundice in newborns does not require special treatment, just let the child eat well and defecate well, as the age of the jaundice will gradually subside. However, physiologic jaundice is an exclusionary diagnosis, meaning that pathologic factors must be ruled out before physiologic jaundice can be considered. What kind of cases should be considered pathological jaundice? Jaundice appears within 24 hours after birth, and is often caused by neonatal hemolytic disease due to blood group incompatibility between mother and baby. 2. When the degree of jaundice is too severe or the rate of rise of bilirubin is too fast. This is difficult to conclude with visual observation, but since the baby is still staying in the hospital for the first few days after birth, medical tests can be used to assist in the determination. Because of the imperfect blood-brain barrier in the early neonatal period, excessive unconjugated bilirubin can combine with the neural nuclei in the neonatal brain, leading to neonatal bilirubin encephalopathy, causing almost irreversible neurological damage and leaving varying degrees of sequelae, and therefore must be treated promptly.3. When jaundice lasts too long Generally speaking, premature infants persist for more than 4 weeks and full-term infants for more than 2 weeks need to be alerted to pathological jaundice. However, there is a special case, namely breast milk jaundice, because a highly active enzyme in breast milk can increase the production and reabsorption of unconjugated bilirubin in the stool, resulting in a prolonged duration of jaundice, which can last even up to 3 months before it subsides, but the growth and development and general condition of babies with breast milk jaundice are very good, no special treatment is needed, and the baby’s brain will not be harmed. To identify whether breast milk jaundice is present, after excluding pathological factors, suspend breast milk for 72 hours, and if the jaundice subsides significantly and serum bilirubin decreases by more than 50% it will help the diagnosis. After the diagnosis is clear, breastfeeding can be continued. During the period of breastfeeding suspension, the mother can freeze the milk, which can be left for the baby to eat later, and can avoid the reduction of milk secretion caused by the baby sucking less. If the jaundice is not severe and other pathological jaundice is ruled out, it is not recommended to suspend breast milk simply to clarify the diagnosis of breast milk jaundice.4. Jaundice recedes and reappears. In other words, the jaundice is gradually receding and then worsens again, so it is necessary to consider whether the baby has an infection or other disease causing abnormal bilirubin metabolism. 5. The serum conjugated bilirubin is significantly elevated. In this case, in addition to jaundice, the baby’s skin color is usually dark and green, commonly known as “yin yellow”, which can be roughly recognized by the naked eye by experienced professionals, but the general public has no experience in this area and mainly relies on observation of the stool. As bilirubin is metabolized and excreted mainly through the intestinal tract, the stool is colored yellow. If you find that your baby’s stool is white like a wall, or just the surface layer of the stool is yellow and the central part is white, or the stool is yellow and white, you need to consider poor bile excretion, such as thick bile or bile duct obstruction, etc. This situation requires prompt consultation. Sometimes the color of the stool described by the parents is not accurate, and it is best for the health care provider to check the baby’s stool in person. Commonly used methods of bilirubin testing include blood sampling for serum testing, end-of-life blood sampling, and transdermal jaundice testing. Due to the influence of the testing instrument, measurement site and measurement technique, although the transdermal jaundice index is less damaging, it does not accurately reflect the serum bilirubin level and can only be used as a screening tool or for dynamic observation of the treatment effect. Once pathological jaundice is suspected, parents should not take any chances and take their baby to the doctor as soon as possible to avoid missing the time for treatment.