What might skin color changes indicate in a newborn?

The color of a baby's skin can often help identify possible problems in another area of the body. It is important for you to detect and notify your baby's doctor if the following skin color changes should occur:

• Increasing yellow color. Over half of all newborns develop some amount of jaundice, a yellow coloring in their skin and eyes, during the first week. This is usually a temporary condition, but may be a more serious sign of another illness. Jaundice is caused by the breakdown of red blood cells. As the old cells are broken down, hemoglobin is changed into bilirubin and normally removed by the liver. In a newborn baby, this removal process is not fully developed. The buildup of bilirubin in the blood is called hyperbilirubinemia. Because bilirubin has a pigment, or coloring, it causes a yellowing of the baby's eyes, skin, and tissues. As liver function matures, the jaundice goes away. A premature infant is more likely to develop jaundice. The yellow tint to the skin can often be seen by gently pressing on the baby's forehead or chest and watching the color return. There are several types of jaundice:

  • Physiologic jaundice. Physiologic jaundice occurs as a "normal" response to the baby's limited ability to excrete bilirubin in the first days of life.

  • Breast milk jaundice. About 2% of breastfed babies develop jaundice after the first 3 to 5 days. It peaks about 2 weeks of age and can persist up to three to 12 weeks. Breast milk jaundice is thought to be caused by a factor in the mother's breast milk that increases the reabsorption of bilirubin through the intestinal tract. This process is called enterohepatic circulation.

  • Breastfeeding failure jaundice. It is caused by failure to initiate breastfeeding, resulting in dehydration, decreased urine and stool production and accumulation of bilirubin. Late preterm infants, those who are born between 34 weeks and 36 weeks, are more susceptible to this problem. They do not have the coordination and the strength to maintain a successful breastfeeding.

  • Jaundice from hemolysis. Jaundice may occur with the breakdown of red blood cells due to hemolytic disease of the newborn (Rh disease), having too many red blood cells, or bleeding internally.

  • Jaundice related to inadequate liver function. Jaundice may be related to inadequate liver function due to infection or other factors.

  Treatment for jaundice depends on many factors, including the cause and the severity of the jaundice. Treatment often includes using special lights called phototherapy. Babies with severe jaundice may need hospitalization and blood transfusions.

  Babies with jaundice may have feeding problems and be irritable or listless. Call your baby's doctor if your baby has any of these signs.

• Blue color that does not go away. When a baby is first born, the skin is a dark red to purple color. As the baby begins to breathe air, the color changes to red. This redness normally begins to fade in the first day. A baby's hands and feet may stay bluish in color for several days. This is a normal response to a newborn's immature blood circulation.
  
  Blue coloring of other parts of the body is not normal. Occasionally, a baby's face or lips and mouth may turn purplish with very intense crying. However, this should turn back pink when the baby stops crying. If the baby's color does not turn pink again, or there is an overall blue tinge to the baby, this may signal a problem. The blue coloring is called cyanosis and is often seen in babies with a heart defect, because the heart cannot pump the oxygenated blood to the rest of the body. Breathing difficulties may also cause cyanosis. Consult your baby's pediatrician immediately if your baby has any blue coloring.