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Jaundice in newborns

 

Mild jaundice in babies is very common: around half of newborn babies get it. It is most noticeable from the third day after birth. 

Jaundice is usually harmless and disappears after a week or two without problems. Nonetheless, a nurse or doctor should check and monitor all cases of jaundice in newborn babies. Some babies have severe jaundice, which very occasionally can lead to deafness and even brain damage if not treated promptly.

What causes it?

The normal breakdown of red blood cells causes jaundice. This process releases a chemical called bilirubin, which makes skin yellow. Babies break down red blood cells very rapidly, but their livers aren’t really developed enough to dispose of bilirubin. This overload causes physiological jaundice.

Newborns can also get breastmilk jaundice, where a chemical secreted in the mother’s milk interferes with the disposal of bilirubin. This usually fixes itself after several weeks and does not require treatment.

A rare type of jaundice occurs when the mother’s and the baby’s blood groups are incompatible. This is not usually a problem during a first pregnancy because the mother’s and the baby’s bloodstreams do not mix. However, during the delivery, some of the baby’s blood may mix with the mother’s blood. The mother then develops antibodies which become active during the next pregnancy and cross the placenta to attack the second baby’s red blood cells. Their destruction releases bilirubin into the baby’s bloodstream, and jaundice appears.

If this has happened, it usually becomes apparent in the first 24 hours after birth.

 How is it treated?

Treatment depends on what caused the jaundice and how bad it is. Babies who develop jaundice several days after birth usually just require careful monitoring, sometimes with heel prick blood tests to check the bilirubin levels in their blood. If these are high, the hospital staff may recommend a few days’ treatment with phototherapy. This technique uses ultraviolet light to help to break down excess amounts of bilirubin. The baby is placed naked, with eyes covered to protect them, in the cot, under a blue phototherapy lamp for 2-3 days. Most babies tolerate the treatment and there are minimal side effects – possibly a mild rash and watery bowel motions for a few days. Because more fluid is lost during phototherapy, your baby may require extra feeds at this time.

More severe jaundice, in which bilirubin levels are very high, may require treatment with an exchange transfusion in which your baby’s own blood is replaced by compatible fresh blood. This is not common.

If your baby has breastmilk jaundice, it does not mean that you need to stop breastfeeding. Rather, talk to your nurse or doctor about alternating between breast and infant formula feeds.

 Do I need to see the doctor?

Take your child to the doctor if:

  • your child is unwell, feeding poorly and not gaining adequate weight
  • your baby develops jaundice in the first 48 hours after birth
  • the jaundice becomes more noticeable after a week
  • the jaundice has not disappeared after two weeks.

Can I prevent it?

Only ‘incompatible blood’ jaundice is preventable. The mother is given an anti-D injection immediately after delivery and this prevents complications in subsequent pregnancies.