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What Are the Causes and Symptoms of Jaundice?

US News & World Report - Health 9/27/2022 Ruben Castaneda
Beautiful latin american newborn baby in incubator getting treated for jaundice © (Getty Images) Beautiful latin american newborn baby in incubator getting treated for jaundice

If your skin isn’t its usual color, it may simply mean you've spent too much time in the sun. In some cases, though, a skin color anomaly may be something you want to get checked out by your health care provider. Lobster-like red skin is a typical sign of sunburn. Angry-looking red welts can signify measles. And yellow-tinged skin or eyes can signal jaundice, a condition that afflicts 60% of all babies, and can also occur in adults. Newborns and elderly individuals are most likely to contract jaundice, according to the National Institutes of Health.

Jaundice is caused by an excess in the body of bilirubin, a yellowish compound in the blood that forms after red blood cells break it down. Bilirubin moves through the digestive tract, gallbladder and liver before being excreted by the body. High bilirubin levels in adults may be a sign of an underlying health condition.

What Causes Jaundice in Babies?

Infants are at-risk for jaundice once they’re born. Asian babies are more susceptible to contracting jaundice, as are infants who are born prematurely and those suffering from dehydration, says Dr. Gina Posner, board-certified pediatrician at MemorialCare Orange Coast Medical Center in Fountain Valley, California. Research suggests that East Asian babies have inherently higher levels of bilirubin at birth.

Dehydration makes a baby more susceptible to jaundice because it reduces the natural secretion of the bilirubin breakdown process through kidney and urine production, says Dr. Jonathan Auth, a pediatrician with Children's Health Orange County in Orange, California.

Dehydration can be a consequence of not getting enough milk early on. Reduced milk intake translates into less stool production, which compromises the natural excretion process. When there is suboptimal milk intake, less bilirubin is eliminated through the stool and can be re-absorbed by the intestines back into the liver, says Dr. Pearl Chang, a pediatric hospitalist at Seattle Children's Hospital.

Babies born prematurely are more at-risk for jaundice because their livers may not be developed enough to efficiently metabolize bilirubin, according to a 2012 study in the Journal of Perinatology.

There are a handful of ways jaundice can occur in babies, Auth says.

  • Physiologic jaundice. During pregnancy, the placenta removes bilirubin. When the baby is born, the baby’s liver must take over this function. When the baby’s liver isn’t developed enough to efficiently get rid of bilirubin, the child may develop jaundice. "Physiologic jaundice occurs as a 'normal' response to the baby’s limited ability to process and excrete bilirubin in the first days of life," Auth says. "Most healthy babies will have physiologic jaundice, which will typically appear 2–4 days after the baby is born and usually goes away by the time a baby is two weeks old."
  • Jaundice from hemolysis. Jaundice may occur with the breakdown of red blood cells due to hemolytic disease of the newborn, caused when the baby and the mother’s blood types are incompatible, Auth says. It may also occur when the baby has too many red blood cells that break down naturally and release bilirubin. This can occur when the baby's liver doesn't remove enough bilirubin to avoid an excess of the substance.
  • Jaundice from impaired liver function. Jaundice may be related to inadequate liver function due to infection or inflammatory or genetic factors.
  • Breast milk jaundice. A very small number of breastfed babies begin to develop jaundice when they are two to 12 weeks old, which may be due to certain compounds in human breast milk which can prevent the liver from quickly removing bilirubin.

Symptoms of Jaundice in Infants

Infants who have jaundice typically have a yellowish tinge to their skin or the whites of their eyes, and may be more sleepy than usual, Posner says. “In children, it usually comes with some sort of virus, so they also look yellow accompanied by vomiting and/or abdominal pain,” she says.

Severe jaundice that is left untreated for too long can in rare cases cause a condition called kernicterus – which can cause brain damage, hearing loss, intellectual disabilities, issues with vision and teeth and even athetoid cerebral palsy, says Michael Urban, senior lecturer and program director for the doctorate of occupational therapy program at the University of New Haven's School of Health Sciences.

Treatment of Jaundice in Infants

In babies, mild cases of jaundice often resolve on their own in up to three weeks, when the yellowish tinge disappears from the infant’s skin and eyes. More serious cases of jaundice in babies may require the infant to remain in the hospital. If the baby and his or her mom have already left the hospital, they may have to return.

In more serious cases of jaundice in babies, doctors may need to provide treatment aimed at lowering the level of bilirubin in the baby’s blood.

These treatments can include:

  • Blood transfusion. If other methods aren’t effective in treating jaundice in a baby, doctors may recommend a blood transfusion. Small amounts of blood are drawn from the infant, which is replaced with blood from donors. This would dilute the bilirubin. It’s rare that this procedure is needed.
  • Boosted nutrition. Supplementation or increased feedings can help ensure a baby with a more serious case of jaundice receives the nutrition he or she needs.
  • Phototherapy. Also known as light therapy, this treatment involves placing a baby under a lamp that emits light in the blue-green spectrum. The light helps the child excrete bilirubin by changing the shape and structure of bilirubin molecules.

What Causes Jaundice in Adults

There are a number of causes of jaundice in adults that are associated with the liver’s inability to process bilirubin, says Dr. Jamile Wakim-Fleming, director of the fatty liver disease program at Cleveland Clinic.

These include:

  • Medication-related toxicity. Taking medication can cause liver toxicity in some individuals. This can be the case with acetaminophen, which is sold under the brand name Tylenol, which is a medication used to treat pain or fever in children and adults. Toxicity can occur when a patient takes more than the recommended dose, which is 4 grams at a time in one day for adults, and 90 milligrams a day in children.  Taking multiple doses exceeding two grams in a 24-hour period over the course of five days or more may also cause cumulative liver toxicity, says Dr. Anurag Maheshwari, assistant professor of medicine at the University of Maryland School of Medicine in Baltimore. He also practices at Mercy Medical Center in Baltimore.
  • Taking the recommended dosage of antibiotics, like augmentin, can also lead to liver toxicity. Augmentin is used to treat a number of conditions, including respiratory tract infections and bacterial sinusitis.
  • In a small number of people, supplements can cause liver toxicity, Maheshwari says. Dozens of supplements may cause liver toxicity, including supplements for vitamins A and D and fat-soluble vitamins.
  • Autoimmune disorders, like autoimmune hepatitis.
  • Cirrhosis of the liver, cause by excessive alcohol use or fatty liver disease.
  • Metabolic disorders of the liver, such as Wilson's disease or hemochromatosis.

Blockage of the bile ducts is associated with the inability to excrete bilirubin, and can lead to these conditions which can cause jaundice:

Symptoms of Jaundice in Adults

In adults, jaundice is often caused by an infection. These infectious conditions can cause jaundice:

  • Acute hepatitis A, B, C, D or E.
  • Chronic hepatitis or inflammation of the liver.

Adults with jaundice may experience these symptoms:

In adults, jaundice not caused by an infection may be associated with liver disease. In that case, symptoms may include itchy skin or weight loss.

Jaundice that’s associated with liver disease may be specifically caused by:

  • Pyoderma gangrenosum, a rare skin disease that causes painful sores on the skin, usually on the legs.
  • Polyarthralgias, a condition that causes pain and inflammation in multiple joints.

Treatment of Jaundice in Adults

In adults, the underlying cause or causes of jaundice are often the focus of treatment rather than treating jaundice itself, Urban says.

Treatments for jaundice in adults can include:

  • Antiviral medications, if the jaundice is caused by hepatitis.
  • Asking your health care provider whether you should change medications, or if jaundice is a side effect of prescription meds.
  • Bile duct surgery, if the jaundice results from an obstruction blocking the bile duct.
  • Removal of your gallbladder, if gallstones are causing the jaundice.

Is Jaundice Contagious?

It’s important to keep in mind that jaundice is not contagious, says Dr. Chantel Strachan, an internist and assistant professor of medicine at Columbia University Medical Center. You won’t get jaundice from someone you have contact with, and if you have jaundice, you can’t pass it to someone else.

“You get jaundice either due to increased production of bilirubin, abnormalities with the processing of bilirubin by the liver, or issues with clearance of bilirubin from the body,” Strachan says.

Copyright 2022 U.S. News & World Report

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