Jaundice (Newborn)

Jaundice is the yellowish colour of the skin due to the presence of bilirubin (a breakdown product of red blood cells) which is removed from the bloodstream by the liver and excreted in the stools and urine.

Physiological (normal) Jaundice occurs in more than half of all babies. Immaturity of the liver leads to a slower excretion of bilirubin. Jaundice first appears at 2 to 4 days of age, reaches it maximum level at about 4 -6 days of age, and disappears by 2 weeks of age.

Breast milk Jaundice occurs later at 4 to 7 days of age, and may last from 3 to 10 weeks.

Jaundice in newborns first appears as yellowness of the skin of the face, which progresses down the body as the level of Jaundice increases. This yellowness can also be seen in the white of the eyes. There are no other common signs or symptoms of Jaundice.

When there are very high levels of bilirubin, babies may be excessively irritable, sleepy or disinterested in feeding. If left undiagnosed and untreated, the high Jaundice may damage the developing brain.

If your newborn appears Jaundiced in the hospital, the nurse or doctor may do a Jaundice screen with a device applied to the skin (transcutaneous bilirubinometer), and confirm the bilirubin level by a blood test from a heel prick.

Based on your newborn's age and level of bilirubin, the doctor will advise you on what to do. Phototherapy may be needed in a small proportion of newborns before discharge, or you will be advised to bring your baby to the doctor within 24 - 72 hours after discharge to review your baby's Jaundice and feeding pattern.

Please bring your newborn to the doctor if:

• Your baby develops Jaundice during the first 48 hours of life, if the level of Jaundice increases rapidly to involve the lower tummy and legs, or jaundice is still present after day 14 of life
• You have difficulty with breastfeeding, the baby does not pass adequate amounts of stool and urine, and appears more Jaundiced.
• Your baby's stools turn cream-beige or chalky-white, or if the urine is dark (tea-coloured), and baby continues to have Jaundice after day 14 of life.

Newborns with higher chances of Jaundice may have one or more of the following:

• Blood group incompatibility between mother and newborn (Rhesus or ABO). Jaundice may rapidly rise and begin early (by 24 to 48 hours of life).
• Babies who have Glucose-6-Phosphate Dehydrogenase deficiency (G6PD) may also get early Jaundice.
• Late preterm babies who are born between 34 to 36 weeks. They develop Jaundice due to their less mature liver system.
• Newborns who have bruising or a collection of blood on the scalp (cephalohaematoma) during process of delivery.
• Newborns whose parents or siblings had severe newborn Jaundice.
• Mothers who experience problems with breastfeeding during the first week of life.

Blue-light phototherapy is used to treat jaundice in the hospital. Your baby will be kept undressed under the phototherapy lights for about 24 hours, and taken out for feeding and change of diapers. Blue light can be given using an overhead bank of lights, or via a blanket-like device. Each has its own advantages.

During phototherapy, some babies may need supplemental fluids if recommended by the doctor. Generally, you can continue to breastfeed. If you are separated from your baby during this period, remember to continue expressing your breast milk 6 to 8 times every 24 hours to maintain your milk supply and prevent engorgement.

In the minority of cases where bilirubin levels increase rapidly to very high levels, a blood exchange therapy is performed to lower bilirubin levels in the hope of preventing brain damage.

Giving water or glucose feeds will not lower the jaundice. Sunlight does not effectively reduce the Jaundice. No oral or tropical medicine is available to decrease the Jaundice. Since bilirubin is excreted from the body in the stools, breastfeed your baby frequently to encourage frequent bowel movement.

After completing phototherapy, the baby will be discharged or observed for a rise in bilirubin depending on individual circumstances.

An early appointment in one or two days' time will be made if baby is less than 7 days old to check bilirubin levels again.

Sunbathing can cause the baby to become dehydrated, or sun burnt. It does not help to reduce or prevent Jaundice.

Avoidance of herbal therapies in breastfeeding mothers will also help to reduce the rise in Jaundice.