It is both normal and common for healthy newborn infants to become jaundiced. In term infants this occurs in about 15% and more frequently in preterm. Jaundice is a sign not a disease as long as the level of bilirubin does not go over values considered to be safe. The most common jaundice in term newborn infants is physiological and it seldom reaches severity that might be harmful.
In a small proportion of infants jaundice is a sign of serious disease. In those cases it usually appears early and/or it becomes severe. The most common causes of severe jaundice are haemolytic diseases of different etiologies and infections. In countries with no prevention of Rh-iso-immunization or with other specific problems such as glucose-6-phosphate dehydrogenase deficiency severe forms of jaundice are more frequent than elsewhere. Jaundice in preterm infants can be a combination of the immature organism not being able to metabolize bilirubin, and diseases. It should be considered a more serious problem than in term infants. Poor clinical practices can contribute significantly to the level of jaundice.
Phototherapy is an effective treatment for most newborns with moderately severe jaundice. Phototherapy is considered a safe intervention without known side-effects. However, it usually involves hospital admission of the infant with separation from the mother, and negative consequences for breastfeeding and mother-infant relation. Interventions aimed at lowering serum bilirubin values are performed too often in term infants (Newman & Maisels 1990, 1992). When the values of bilirubin exceed levels considered safe exchange transfusion is indicated - at what exact values will dependent on the age of the infant, gestational age and other problems (Provisional committee for quality improvement and subcommittee on hyperbilirubinaemia 1994). It has never been proven that bilirubin values <340 ìmol/l are harmful for term infants not suffering from haemolytic disease (Scheidt et al 1990, Newman & Klebanoff 1993, Seidman et al 1994). However, all these recommendations are based on observations and studies in developed countries.