What is jaundice?
Jaundice is the name given to yellowing of the skin and the whites of the eyes.
Newborn babies produce large quantities of the pigment bilirubin. This is the substance that gives the yellow colour to the skin and whites of the eyes. Bilirubin is a product of the breakdown of red blood cells. It is normally processed by the liver and passed out of the body through the bowels in stools (faeces). The skin and eyes turn yellow in jaundice because there is an increased amount of bilirubin in the body.
Most babies who develop jaundice do not need treatment or extra monitoring. However, a few babies will develop very high levels of bilirubin, which can be harmful if not treated. In rare cases, it can cause brain damage.
The aim is to help prevent or detect very high levels of bilirubin and identify babies who have jaundice because of liver disease.
If you think your baby is jaundiced the doctor or midwife will be able to help you judge whether or not the jaundice needs treating.
Is jaundice common in newborn babies?
Jaundice in newborn babies is very common and is usually harmless. It gradually disappears by the time your baby is ten to fourteen days old. This may take a bit longer if your baby is premature, in which case it can take about three weeks to disappear.
Jaundice in the first 24 hours of birth
Jaundice can occur within the first twenty-four hours after birth, but this is rare. If this happens it may indicate a more serious underlying condition and it is important for a paediatrician to see your baby. They will discuss the possible causes and any treatment that maybe required.
Which babies are more likely to develop jaundice that needs treatment?
- babies who were born early (at less than 38 weeks of pregnancy)
- babies who have a brother or sister who had jaundice that needed treatment as a baby
- babies whose mothers breastfeed exclusively
- babies who have signs of jaundice in the first 24 hours of life
How do I know if my baby is jaundiced?
Your baby will be checked for signs of jaundice at every opportunity, especially in the first 72 hours. This will include looking at your naked baby in bright light (natural light if possible) to see if they appear yellow. You can detect jaundice more easily by pressing lightly on the skin. A yellowing of the whites of the eyes and the gums are helpful indicators of jaundice, particularly in babies with darker skin tones. You or the doctor or midwife can carry out the check.
What do I do if my baby looks jaundiced?
Please contact your midwife as it is important that the level of bilirubin is measured. Measuring the level of bilirubin can be done very simply for most babies, using a special hand-held device placed briefly on the skin (a ‘bilirubinometer’). It won’t hurt your baby. If the reading is high your baby will need a blood test. Babies who are jaundiced in the first 24 hours and babies born prematurely (less than 35 weeks of pregnancy) will need a blood test.
The doctor or midwife will use the results of these tests to decide whether the jaundice needs to be treated, and what kind of treatment would be best.
Treating jaundice
If your baby needs treatment for jaundice, this will be done in hospital. Your baby will be monitored to see if the treatment is working, and tests for conditions that may have caused the jaundice will be carried out.
The doctor or midwife will tell you about the treatments for jaundice and give you appropriate information. The information will include:
- the different options available, why they are being considered and how they can help treat jaundice (see below)
- benefits, possible problems and any long-term effects of the treatments
- what the treatment involves
- how long the treatment is likely to last
- what will happen if the treatment does not work
- how you can hold, touch and feed your baby during their treatment.
Phototherapy
If the doctor or midwife decides that treatment is needed because your baby’s bilirubin level is higher than expected, your baby will be treated using phototherapy.
Phototherapy involves placing your baby under a special light (not sunlight). Light of a certain wavelength helps the body to break down the bilirubin and pass it out of the body.
During phototherapy your baby’s eyes will be protected and they will be given routine eye care. Your baby’s temperature will be monitored and your baby will be checked to make sure they stay hydrated (have enough fluid in their body). This is done checking how feeding is going, assessing their wet nappies and weighing your baby every day they are having treatment.
The treatment may be stopped from time to time for up to 30 minutes so you can hold, feed and cuddle your baby, and change their nappy. You will be given help with feeding.
Intensified phototherapy
If your baby’s bilirubin level is very high or rising quickly, or if your baby’s jaundice does not improve after phototherapy, your baby’s treatment will be stepped up. This involves increasing the amount of light used by adding another light source at the same time to give more light. During intensified phototherapy the treatment will not be stopped for breaks or feeding. However, you can express your breast milk, which can then be given to your baby through a feeding tube that passes up your baby’s nose and into their stomach. Rarely, fluids may be needed and these are given straight into a vein using a ‘drip’.
Your baby can be breastfed normally again after intensified phototherapy is stopped, and you will be offered extra help with this.
Checking to see if phototherapy is working
The level of bilirubin in your baby’s blood will need to be checked with a blood test every 4–6 hours after starting phototherapy to see if the treatment is working. Once the levels of bilirubin become stable or fall, they will still have to be checked every 6–12 hours. When your baby’s jaundice does get better, phototherapy can be stopped but your baby will need another blood test 12–18 hours later to make sure the jaundice has not returned to a level that would need further treatment. Your baby won’t necessarily have to stay in hospital for this.
Other treatments for jaundice
If the level of bilirubin in your baby’s blood is very high, your baby might need a complete changeover of blood (an exchange transfusion) because this is the quickest way to lower the bilirubin levels. Your baby will need to be admitted to an intensive care bed for this. After the exchange transfusion your baby will need a blood test within 2 hours so that the bilirubin level can be checked to see how well the treatment has worked. If your baby has haemolytic disease (this is when antibodies in the mother’s blood attack the baby’s blood cells) and their blood bilirubin level is rising rapidly, the doctor may suggest a treatment called intravenous immunoglobulin (sometimes called IVIG), which is a blood product. Intravenous means it needs to be injected into a vein.
Jaundice lasting longer than expected
If your baby has jaundice that lasts longer than your doctor or midwife expects they will check for pale, chalky stools and/or dark urine and further blood and urine tests will be needed.
If jaundice continues beyond 14 days of age in a full-term baby or 21 days in a premature baby then you will be asked by your midwife or health visitor to see a paediatrician. Your baby will be examined and blood tests will be taken to ensure your baby is well.