Why is your skin yellow?
When you hear the word “jaundice,” you probably think of a baby that has to spend time under a special light in order to fix it. Most people are surprised to know that adults can become jaundice, too. What causes jaundice to occur? Is it the same for adults and children? Can anything be done to prevent it?
Jaundice occurs when your body has high levels of bilirubin (hyperbilirubinemia). Bilirubin is formed by the breakdown of red blood cells that your liver filters out of your bloodstream. Your liver uses bilirubin to help form bile. Bilirubin has a yellow-orange pigment and when there is an excessive amount in your bloodstream, it causes your skin, sclera (whites of your eyes) and mucous membranes (mouth, etc.) to become yellow. The reason it is common in infants is that often their liver isn’t mature enough to remove bilirubin from their bloodstream quickly enough, so they can end up jaundice. This is particularly true for infants who are born before 38 weeks gestation and some babies who are breastfed and having difficulty nursing or getting enough nutrition from breastfeeding. This can lead to dehydration and low-calorie intake meaning the baby doesn’t have frequent enough bowel movements to get rid of the bile that contains bilirubin. Two other causes can be significant bruising during birth, which results in more red blood cells being broken down than the liver can initially filter out, or if the mother’s blood type is different from the baby’s (the baby can receive antibodies through the placenta that causes their blood cells to break down more quickly). Symptoms appear within the first seven days of life, but most often between the second and fourth day. This is why it is important to have your baby examined by a doctor within two days of discharge, especially if they were discharged earlier than 72 hours after birth. If your baby’s skin becomes more yellow, they seem listless/sick/difficult to awaken, they aren’t gaining weight or feeding poorly, makes high-pitched cries, develops any other symptoms that concern you or their jaundice lasts more than three weeks, then you should see a doctor. In extremely high levels, bilirubin can be toxic to brain cells. If the levels get too high, they can cause a condition called acute bilirubin encephalopathy, which can lead to permanent brain damage (a condition called kernicterus). Symptoms of acute bilirubin encephalopathy include listlessness/difficulty waking, high-pitched crying, poor sucking/feeding, backward arching of the neck and body, fever and vomiting. People affected by kernicterus have improper development of tooth enamel, hearing loss, permanent upward gaze and involuntary, uncontrolled movements (aka athetoid cerebral palsy). This is why any change in your baby’s condition should be evaluated by a doctor immediately.
For adults, jaundice usually occurs because there is a problem during one of the three phases of bilirubin production. It can occur before the production of bilirubin (aka unconjugated jaundice) due to increased levels of bilirubin from the reabsorption of a large collection of clotted or partially clotted blood under the skin (hematoma) or hemolytic anemias (blood cells are destroyed and removed from the bloodstream before their normal lifespan is over). Jaundice can occur during the production of bilirubin from a variety of reasons, including viruses (Hepatitis A, chronic Hepatitis B or C and Epstein-Barr virus infection—infectious mononucleosis), alcohol, autoimmune disorders, rare genetic metabolic disorders and certain medications (acetaminophen, penicillin, oral contraceptives, chlorpromazine and estrogenic/anabolic steroids). Jaundice caused after bilirubin is produced is most often from gallstones, gallbladder inflammation, gallbladder cancer and pancreatitis. Some adults don’t have any symptoms of jaundice, but it is found that their bilirubin levels are high due while they are seeking treatment for something else. Typically, if you have jaundice caused by an infection (short-term), it will cause you to have fever, chills, abdominal pain, flu-like symptoms and yellowing of your skin. If your jaundice is caused by a chronic condition (long-term), you can experience weight loss and itchy skin (pruritus) because the excess bilirubin makes it way to your skin cells causing the itching.
For infants, if their jaundice isn’t severe, treatment might not be necessary. Your doctor may recommend more frequent feedings in order to increase the number of bowel movements that your baby is having. Also, the doctor may recommend supplemental feedings of formula, if you are having trouble breastfeeding and they are concerned that your baby is losing weight or dehydrated. Usually, mild jaundice disappears on its own within two to three weeks. If your baby does need treatment for jaundice, the most common form is non-invasive. Phototherapy (light therapy) is used to change the structure and shape of the bilirubin molecules in a way that makes them easier to be excreted in urine and stool. Your baby will be placed under a special light that emits light on a blue-green spectrum (not ultraviolet) wearing only their diaper and special plastic shields over their eyes. For babies who have an incompatibility with their mother’s blood type, they may be given an intravenous (IV) transfusion of immunoglobulins (a blood protein) to help reduce the levels of antibodies. In severe cases, if this doesn’t work, your baby may need an exchange transfusion. This is where small amounts of blood are repeatedly withdrawn, then diluted to reduce the amount of bilirubin and maternal antibodies before being infused back into your baby. Due to the complexity of this procedure, it is done in the newborn intensive care unit.
For adults, their jaundice doesn’t usually need to be treated, but the underlying condition does. For short-term types of jaundice, this can mean taking it easy, drinking plenty of water to stay hydrated and being careful to not injure your liver further while recovering from an infection. For individuals who long-term types, the best treatment is management of the condition that causes jaundice to occur and if they are having itching, it can be controlled by a medication called cholestyramine.
For infants, prevention of jaundice isn’t possible if it is caused by an incompatibility between the mother’s and baby’s blood types. For types caused by your infant’s immature liver or significant bruising during birth, it is essential to ensure that your baby is getting adequate feedings throughout the day to encourage increased bowel movements to help clear out the excess bilirubin. The current recommendations are that breastfed infants have at least 8 – 12 feedings a day for the first several days of their life and formula-fed infants should have 1 – 2 ounces of formula at least every two to three hours for the first week of their life. For adults, due to the wide number of causes of jaundice there are no specific guidelines for prevention. Some general tips are to avoid hepatitis infections, don’t consume large amounts of alcohol on a regular basis, maintain a healthy weight and keep your cholesterol within recommended limits.
Jaundice is an indication that something is amiss within your body in regards to the function of your red blood cells and your body’s ability to process their break down. By seeking the treatment that you or your baby needs, it is something that is easily curable. If you have any questions or concerns about jaundice, please speak with your or your baby’s doctor. If you would like more information about jaundice in infants, please visit University of Rochester’s Medical Center’s Hyperbilirubinemia in Newborns page at https://www.urmc.rochester.edu/encyclopedia/content.aspx?ContentTypeID=90&ContentID=P02375 If you would like more information about jaundice in adults, please visit the Merck Manual’s Jaundice in Adults page at https://www.merckmanuals.com/home/liver-and-gallbladder-disorders/manifestations-of-liver-disease/jaundice-in-adults