Ask the Rav: The number level of jaundice/bilirubin for which a Bris must be delayed

1. Question: [Monday, 8^th Mar Cheshvan, 5781]

What number jaundice is considered too high for a Bris to be able to be done on a baby?

Answer:

While it is clear from the Shulchan Aruch that yellowness, known as jaundice, is considered a type of illness for which we abstain from circumcising until it is healed, nonetheless, there is a difference between jaundice that is due to infection which is known as pathological jaundice, versus jaundice that comes as a result of high bilirubin levels in the blood which is known as physiological jaundice. Regarding the latter, there are numerous approaches on this matter amongst Rabbanim and Mohalim in terms of the definition of a high enough level of jaundice, which is based on the bilirubin level found in the blood as well as the color of the baby, to justify or obligate the delay of the circumcision. The Chabad approach in this matter is more stringent than that of other sects, in light of the statement of the Shulchan Aruch that it is always possible to circumcise while it is never possible to return a life. The Lubavitcher Rebbe directed, based on the ruling of the Tzemach Tzedek, that in cases of high-level jaundice one is to wait seven complete days after the child has been healed of his high level of jaundice, and so is the Chabad custom. Many of the Poskim however rule that it is never necessary to wait seven days for natural jaundice that is not the result of an infection, being that it is not defined as an illness, and one simply has to wait until it goes down to a normal level. Regarding the number level of bilirubin jaundice for which a circumcision is to be delayed and requires a seven-day wait, there are different approaches even amongst Chabad rabbis and Mohalim.

The ruling of Rabbi Zalman Shimon Dworkin: Rabbi Zalman Shimon Dworkin was of the following opinion: Until number 10, the circumcision may take place on time. From number 10 until 15 when is to wait until the number descends below 10 and he may then immediately be circumcised the next day. If however the number read above 15 then the child is considered sick and one must wait seven full days after the number descends to below 10. [Heard from Rav Yosef Simcha Ginzburg, in name of the Mohel Rabbi Moshe Klein]

The ruling of Rabbi Ellie Landa: Rav Eli Landau, who is himself a veteran Mohel, related to me that his father ruled, as well as other rabbis, that if the bilirubin level is above 13 than one should wait 7 days [from when it goes down below 11], and that he personally does not do a Bris if the number is above 11. In addition, he noted that when relying on a machine to determine the bilirubin level, one should not rely only on one machine, as often they are not all accurate. A blood test is the most accurate way of determining the number. Also, he relates that he does not rely only on the number but also on the color of the baby, near the naval area. 

Sources: See Michaber Y.D. 263:1; Rambam Mila 1:17; Abayey and Rav Nasan in Shabbos 134a; Beis Yitzchak Y.D. 2:90-5; Mishmeres Shalom 263:3; Minchas Yitzchak 3:25; Nishmas Avraham 263; Encyclopedia Hilchatit Refuit 4 Erech Mila pp. 547-562; Pesakim Uteshuvos 263:1-2

Poskim who rule that seven-day wait is never necessary: Bach 263; Derech Pikudecha; Chochmas Adam 149:4; Avnei Nezer Y.D. 320;Aruch Hashulchan 263:3; Tzitz Eliezer 13:81; Shevet Halevi 3:142; See Pesakim Uteshuvos 263 footnote 3 for a long list of both Rishonim and Achronim who all ruled that it is not necessary to wait seven days. See there also for the list of those Poskim who are you and ruled that it is necessary.

Chabad approach: See Tzemach Tzedek in Piskeiy Dinim 263 to wait seven days; Likkutei Sichos Tazria 3; Igros Kodesh 7:143; Heichal Menachem 1:47