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  4. Jaundice in Newborns

Newborn jaundice is a term which describes yellowing of the baby’s skin and the sclera, the white part of their eyes. Newborn jaundice is very common and is often called physiological jaundice. Around 60% of newborn, full-term babies will develop some level of jaundice and around 80% of premature babies will become jaundiced.

There are a range of reasons why newborns can become jaundiced, mostly due to their immaturity. It’s worth knowing that breastfed babies are more likely to become jaundiced than formula fed babies. But this is not a reason to stop breastfeeding. Breast milk jaundice happens when a chemical in the breast milk interferes with the how bilirubin is excreted. There is no treatment for breast milk jaundice and it settles by itself.

What causes jaundice in newborns?

When levels of bilirubin (bile) are high, the baby’s skin takes on a yellow or light orange appearance. Bilirubin is a by-product of old red cell breakdown. In mature babies, the liver processes bilirubin, mixes it with bile which is then excreted by the baby’s gut. But this process can take a couple of weeks. 

Babies are born with a high level of red blood cells, at a level which is no longer needed when they are breathing on their own. Red blood cells carry oxygen and during pregnancy, the baby’s high stores help with oxygenation.

After birth, the liver processes bilirubin which is then excreted into the baby’s gut and into their poos. Due to the immaturity of the liver at birth, it can take a little while for this organ to remove the bilirubin. 

What are the symptoms of newborn jaundice?

Rarely, babies are born jaundiced. If they are, it can be a sign of gut problems or issues with blood group incompatibility.

Generally jaundice starts 2-4 days after birth and peaks 3-7 days after birth. The baby’s face looks yellow and the whites of their eyes take on a yellow hue. Typically their face is the first area to become yellow. Gradually, the jaundice spreads down over their trunk and the rest of their body. When a finger is pressed lightly onto the baby’s skin and there is a yellow, rather than pale tinge, this is a sign of jaundice.

Jaundiced babies can be sleepy as their liver is working hard to remove the high levels of bilirubin.

How to prevent jaundice in babies

There’s not much which can be done to prevent (normal) physiological jaundice. When blood incompatibility is detected during pregnancy, the mother and her baby are monitored closely. Sometimes a blood transfusion is needed while the baby is in utero or shortly after birth. Small amounts of donor blood are mixed with the baby’s blood so that the bilirubin is diluted.

Jaundice is more common in

  • Premature babies e.g. born before 37 weeks of gestation.
  • Babies who are small for gestational age (SGA).
  • Babies with a blood abnormality. 
  • Where there is an incompatible blood group between a mother and her baby – Rh incompatibility . Antibodies develop in the baby’s blood which destroys their red blood cells, causing a rise in bilirubin levels. 
  • Twins and multiple births .
  • Babies who were born by assisted delivery or caesarian section. Bruising adds to the level of red cell breakdown so the baby’s liver needs to work extra hard. 
  • Babies who are not feeding well and getting insufficient milk.
  • Babies with liver complications. Biliary atresia is a condition where there are problems with the drainage of bile causing their poos to be pale and their wee dark orange. 
  • Babies who have an infection.
  • Babies with a red blood cell abnormality
  • Babies with an enzyme deficiency.

Risks of jaundice in babies

Jaundice is not dangerous for a baby as long as it stays within a normal range and doesn’t last for too long. If however, if the level of bilirubin is very high and stays high, there can be complications. 

If the level of bilirubin crosses into the baby’s brain, there is a higher risk of deafness, cerebral palsy and other developmental problems. 

Treatment for jaundice

Generally there’s no treatment other than time and feeding. Between a few days and 2-3 weeks, the bilirubin in their bloodstream drops to a normal level. Frequent feeding helps the bilirubin to be passed through the baby’s poos.

If the levels of bilirubin are high in the baby’s blood, they may need phototherapy. Bilirubin can be measured in a baby’s blood which is collected doing a heel prick. Phototherapy is done using a bilirubin blanket which emits a blue light or, the baby sleeping in a cot with ultraviolet lights. Phototherapy lights help to break down the levels of bilirubin. Babies having phototherapy treatment can sometimes develop a nappy rash. 

 See a doctor 

  • If you are worried about your baby.
  • They become jaundiced within the first 1-2 days after birth.
  • Their jaundice becomes more intense or worse.
  • Your baby has a fever.
  • Your baby is sleepy and not interested in feeding.
  • They are not wetting at least six nappies a day or pooing frequently. 

FAQ

Will phototherapy hurt my baby’s eyes?

No, their eyes are covered for protection by using a little mask. 

When will the jaundice go away?

 Generally it takes a couple of weeks for jaundice to settle. Feeding helps to rid the baby’s body of excess bilirubin.

Written and reviewed by Jane Barry, midwife and child health nurse on 19/04/20.