Neonatal Jaundice

If you are expecting or have a newborn baby, biggest congratulations!  Despite the hustle and bustle that comes with your new bundle, you may want to take time to read this article on neonatal jaundice. Jaundice is rarely something to be concerned about however it is good to be aware of what to look out for.

What is Jaundice?

Jaundice is a term used to describe a yellow discoloration of the skin and sclera (whites of the eyes) caused by the accumulation of bilirubin, a bile pigment, which is mainly produced from the breakdown of red blood cells.

Causes of Jaundice

Newborn babies have more red blood cells than adults have, they are also immature, meaning they do not last as long. When they are broken down (normal process), they produce a substance called bilirubin. This bilirubin is normally processed by the liver and excreted out of the body through your baby’s stools. However, commonly, bilirubin is made too quickly for the immature liver to break it down, hence it accumulates, causing jaundice.

Within a few weeks, the number of red cells broken down decreases and the liver is able to break down the bilirubin more quickly. Therefore, for most babies, jaundice disappears by the time they are two weeks old. This describes the commonest type of jaundice, termed ‘physiological jaundice’ and is harmless. This is usually seen between day 2 and 4 of life, increasing to a peak at day 7 and then fades and fully resolves by day 14. The baby is well and has no other problems.

As mentioned, most jaundice is harmless however there are various other causes of jaundice in newborn babies, some of which are more serious and not to be missed. Serious causes can include infections, blood group incompatibility between the mother and baby, as well as, albeit it rare, a liver problem called biliary atresia. As such, let me take you through the signs or ‘red flags’ to look out for and seek immediate medical attention for should your child exhibit any of the following;

– Jaundice starting within the first 24 hours of life

– Jaundice at any age with any of the following; vomiting, irritability, not feeding well, pale chalky stools, dark coloured urine that stains the nappy, signs of dehydration.

– Persistent jaundice; >14 days if a full term baby or >21 days if premature (born at 37 weeks gestation or less).

How to know if you baby is jaundiced?

It is very important to look for jaundice in your newborn at every opportunity, especially in the first 72 hours of life. This should include looking at your baby naked in natural bright light to see if they appear yellow. You can detect jaundice more easily by pressing lightly on the skin to check for signs of jaundice in blanched skin. Yellowing of the whites of the eyes or gums are also another useful indicator. If you think your baby is jaundiced, seek medical advice from your doctor or midwife.

What to do if your baby is jaundiced?

If your baby develops jaundice, then contact your midwife or GP for advice. Although it is not usually a serious problem, it is very important to get it checked to see if you baby needs any treatment. Your baby will usually be routinely checked for jaundice by a midwife within 72 hours of birth.

Tests for Jaundice

If your baby exhibits any of the ‘red flags’ above, common procedure would be to refer to pediatrics the same day for a review. This will likely involve a blood test allowing them to check the level of bilirubin which in turn will indicate treatment. They also may do an ‘infection screen’ to look for an infection as a cause of raised bilirubin and they may perform an ultrasound scan of their liver.

Treatments Available

Treatment depends on the underlying cause. Fluid intake should be encouraged and if breastfeeding, you should continue to do so. Treatment will also be needed for any cause of the jaundice, such as infection.

If the bilirubin is above a certain level or threshold, your baby may be given phototherapy. Phototherapy is a form of light treatment that helps to break down the bilirubin more quickly so your baby can excrete it through their urine or stools. Your baby will likely require frequent blood testing to ensure the level of bilirubin is falling. You are able to touch and talk to your baby and feed them as normal, although you will be advised to feed more frequently.

The jaundice should get better with time, however the exact time will vary from infant to infant. Usually if your baby is feeding well and is having phototherapy, it will improve within a couple of days.

Prognosis

I am pleased to say that the outlook for physiological jaundice and breast-feeding jaundice is excellent and the jaundice will not cause any long-term problems.

At Coyne Medical, we are frequently seeing babies with parental concern regarding jaundice. If you are worried your little one could be jaundiced then please do contact us for advice, especially if there are any of the worrying features outlined above. By writing this article, I hope to have reassured you that not only is neonatal jaundice common, most is harmless with no long term consequences.

Dr. Emma Crawley

GP, Parsons Green