Newborn Jaundice

Newborn Jaundice

Jaundice is a common and usually harmless condition in newborn babies that causes yellowing of the skin and the whites of the eyes. The medical term for jaundice in babies is neonatal jaundice.

Symptoms of Jaundice in newborn babies

Jaundice usually appears about three days after birth and disappears by the time the baby is two weeks old.

In premature babies, who are more prone to jaundice, it can take five to seven days to appear and usually lasts about three weeks. It also tends to last longer in babies who are breastfed, affecting some babies for a few months.

If baby has jaundice, their skin will look slightly yellow. The yellowing of the skin usually starts on the head and face, before spreading to the chest and stomach. In some babies, the yellowing reaches their legs and arms.

Yellowing may appear more pronounced if you press an area of skin down with your finger.

Changes in skin colour can be more difficult to spot if your baby has a darker skin tone. In these cases, yellowing may be more obvious elsewhere, such as:

  • in the whites of their eyes
  • inside their mouth
  • on the soles of their feet
  • on the palms of their hand

 

Other associated symptoms of newborn jaundice can include:

  • poor sucking or feeding
  • sleepiness
  • a high-pitched cry
  • limpness (floppiness)
  • dark, yellow urine (a newborn baby’s urine should be colourless)
  • pale stools (faeces) instead of yellow or orange stools

 

Why does baby has Jaundice?

Jaundice is caused by the build-up of bilirubin in the blood. Bilirubin is a yellow substance produced when red blood cells are broken down.

Jaundice is common in newborn babies because babies have a high level of red blood cells in their blood and these are broken down and replaced frequently. The liver in newborn babies is also not fully developed, so it is less effective at removing the bilirubin from the blood.

By the time a baby is about two weeks old, their liver is more effective at processing bilirubin, so jaundice often corrects itself by this age without causing any harm.

In a small number of cases, jaundice can be the sign of an underlying health condition. This is often the case if jaundice develops shortly after birth (within the first 24 hours).

Who is affected

Jaundice is one of the most common conditions that can affect newborn babies. It is estimated that 6 out of every 10 babies will develop jaundice, including 8 out of 10 babies born prematurely (babies born before the 37th week of pregnancy).

However, only around 1 in 20 babies has a high enough level of bilirubin in their blood to need treatment.

For reasons that are unclear, breastfeeding a baby increases the risk of them developing jaundice, which can often persist for a month or longer. However, in most cases the benefits of breastfeeding far outweigh any risks associated with jaundice.

 

Diagnosing Jaundice in Newborn Babies

Your baby will be checked for jaundice within 72 hours of being born, but you should keep an eye out for signs of the condition after you return home because it can sometimes take up to a week to appear.

When you are at home with your baby, you should look out for yellowing of their skin or the whites of their eyes. Gently pressing your fingers on the tip of their nose or on their forehead can make it easier for you to spot any yellowing.

You should also check your baby’s urine and stools (faeces). Your baby may have jaundice if their urine is yellow (a newborn baby’s urine should be colourless) or their stools are pale.

You should speak to your midwife, health visitor or GP as soon as possible if you think your baby may have jaundice. Tests will need to be carried out to determine whether any treatment will be necessary.

Visual examination

A visual examination of your baby will be carried out to look for signs of jaundice. Your baby will need to be undressed during this so their skin can be looked at under good, preferably natural, light.

 

Other things that may also be checked include:

  • the whites of your baby’s eyes
  • your baby’s gums
  • the colour of your baby’s stools or urine

Bilirubin test

If it’s thought that your baby may have jaundice, the level of bilirubin (the yellow substance produced when red blood cells are broken down) in your baby’s blood will need to be tested. This can be done using:

  • a small device called a bilirubinometer, which beams light onto your baby’s skin. By analysing how the beams of light are reflected off the skin, or absorbed by the skin, the device calculates the level of bilirubin in the blood.
  • a blood test of a sample of blood usually obtained by pricking your baby’s heel with a needle. The level of bilirubin in the liquid part of the blood (the serum) is then measured.

In most cases, a bilirubinometer is used to check for jaundice in babies. Blood tests are usually only necessary if your baby developed jaundice within 24 hours of birth or the bilirubinometer reading is particularly high.

The level of bilirubin detected in your baby’s blood is used to decide whether any treatment is necessary.

 

Treating jaundice in newborn babies

You should speak to your midwife, health visitor or GP if your baby develops jaundice. They will be able to assess whether treatment is needed.

Treatment is usually only necessary if your baby has high levels of a substance called bilirubin in their blood, so tests will need to be carried out to check this.

Most babies with jaundice do not need treatment because the level of bilirubin in their blood is found to be low. In these cases, the condition will usually get better within 10-14 days and won’t cause any harm to your baby.

If treatment is felt to be unnecessary, you should continue to breastfeed or bottle feed your baby regularly, waking them up for feeds if necessary. If your baby’s condition gets worse or does not disappear after two weeks, contact your midwife, health visitor or GP.

Prolonged newborn jaundice (lasting longer than two weeks) can occur if your baby was born prematurely or if he or she is solely breastfed, and it will usually improve without treatment. However, further tests may be recommended if the condition lasts this long, to check for any underlying health problems.

If your baby’s jaundice does not improve over time, or tests show they have high levels of bilirubin in their blood, they may be admitted to hospital and treated with phototherapy or an exchange transfusion.

These treatments are recommended to reduce the risk of a rare but serious complication of jaundice called kernicterus, which can cause brain damage.

Phototherapy

Phototherapy is treatment with light. It is used in some cases of newborn jaundice to lower the bilirubin levels in your baby’s blood through a process called photo-oxidation. Oxidation is the process of adding oxygen to change a substance (in this case, the bilirubin).

The photo-oxidation converts the bilirubin into a substance that dissolves easily in water. This makes it easier for your baby’s liver to break down and remove the bilirubin from their blood.

 

There are two main types of phototherapy.

  • Conventional phototherapy – where your baby is laid down under a halogen or fluorescent lamp with their eyes covered to prevent damage to eyes.
  • Fibre optic phototherapy – where your baby lies on a blanket that incorporates fibre optic cables. Light travels through the fibreoptic cables and shines onto your baby’s back.

In both methods of phototherapy, the aim is to expose your baby’s skin to as much light as possible.

Conventional phototherapy is the treatment tried first in most cases, although fibre optic phototherapy may be used first if your baby was born prematurely. These types of phototherapy will usually be stopped for 30 minutes every three to four hours so that you can feed your baby, change their nappy and give them a hug.

If your baby’s jaundice does not improve after conventional or fibre optic phototherapy, continuous multiple phototherapy may be offered. This involves using more than one light and often a fibre optic blanket at the same time.

Treatment will not be stopped during continuous multiple phototherapy. Instead, milk that has been squeezed out of your breasts in advance may be provided through a tube into your baby’s stomach, or fluids may be provided into one of their veins (intravenously).

During phototherapy, you baby’s temperature will be monitored to ensure they are not getting too hot and they will be checked for signs of dehydration. Your baby may need to have intravenous fluids if they are becoming dehydrated and are not able to drink a sufficient amount.

The bilirubin levels will be tested every four to six hours after phototherapy has started. Once levels start to fall, they will be checked every 6 to 12 hours.

Phototherapy will be stopped when the bilirubin level falls to a safe level, which usually takes a day or two.

Phototherapy is generally very effective for newborn jaundice and it has very few side effects, although your baby may develop a temporary rash or tan as a result of the treatment.

Exchange transfusion

A blood transfusion, known as an exchange transfusion, may be recommended if your baby has particularly high levels of bilirubin in their blood or if phototherapy has not been effective.

During an exchange transfusion, small amounts of your baby’s blood are removed through a thin plastic tube placed into blood vessels in their umbilical cord, arms or legs. The blood is then replaced with blood from a suitable matching donor (someone with the same blood group).

As the new blood will not contain bilirubin, the overall level of bilirubin in your baby’s blood will quickly fall.

Your baby will be monitored throughout the transfusion process, which can take several hours to complete. Any problems that may arise, such as bleeding, will be treated.

Your baby’s blood will be tested within two hours of treatment to check if it has been successful. If the level of bilirubin in your baby’s blood remains high, the procedure may need to be repeated.

Other treatments

If jaundice is caused by an underlying health problem, such as an infection, this will usually need to be treated.

If the jaundice is caused by rhesus disease (when the mother has rhesus-negative blood and the baby has rhesus-positive blood), intravenous immunoglobulin (IVIG) may be used.

The immunoglobulin is a solution of antibodies (proteins produced by the body to destroy disease-carrying organisms) from healthy donors. It is injected into a vein (intravenous).

IVIG will usually only be used if phototherapy alone has not worked, and the level of bilirubin in the blood is continuing to rise.