Jaundice in babies

Jaundice in babies

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Key points to remember

  • jaundice means yellow skin
  • mild jaundice is common in newborn babies – it starts on the second or third day and settles over seven to ten days
  • there are many causes of jaundice
  • some types of jaundice are serious
  • jaundice that appears in the first 24 hours after birth is not normal – it must be checked out
  • jaundice that is still present after two weeks of age should be checked out with a blood test
  • severe jaundice can be serious – with correct early treatment long-term problems are rare

What is jaundice?

Jaundice is the medical word for yellowing of the skin and the whites of the eyes (sclera). The yellow colour is caused by bilirubin (see What is bilirubin?). At low or medium levels, bilirubin does not cause problems. However, bilirubin can be harmful at high levels and can lead to deafness or brain damage (kernicterus) if it is not recognised and treated quickly. 
 

What is bilirubin?

Bilirubin is one of the body’s normal waste products. It is formed when the body recycles red blood cells. These cells contain the haemoglobin that carries oxygen around the body and gives blood its red colour. Bilirubin is a breakdown product of haemoglobin. The liver is the organ that processes bilirubin. Bilirubin then drains to the gut (intestine) through tubes called bile ducts. In the intestine, the bilirubin is digested and changes colour. It gives bowel motions their normal brown colour.
 

Why do babies get jaundiced?

Jaundice is very common – over half of all babies get jaundiced.
 
In most babies jaundice is normal and natural. Babies are born with a large supply of red blood cells. These are recycled and produce a lot of bilirubin. The newborn baby’s liver is slow to process the bilirubin, so it stays around. 
 
The medical term for this type of jaundice in the newborn is physiological jaundice. This type of jaundice does not harm babies. 
 
Some breastfed babies may stay jaundiced for longer than formula-fed babies. This is because of a normal and natural effect of breast milk on the baby’s liver. This type of jaundice is called breast-milk jaundice. It is not harmful.
 
There are many other reasons for jaundice. Some of these can cause problems for the baby if they are not treated.
 

How do I know if my baby’s jaundice is normal?

Jaundice is likely to be normal, if your baby:

  • becomes jaundiced after the first 24 hours of life
  • wakes up of their own accord to demand feeds
  • looks well and feeds well

  • has dirty nappies (bowel motions) that are yellow or green (not pale, white or light beige) in colour. See the Stool colour chart at the UK Children's Liver Disease Foundation website

As the bilirubin level gets higher, your baby:

  • will become more obviously yellow over the whole body
  • may be sleepy and slow to wake up for feeding
  • may feed less well
If you are worried or have questions, ask your midwife or doctor to check your baby.
 

How long will the jaundice last?

In babies normal (physiological) jaundice usually fades away after one or two weeks. Sometimes normal jaundice may last longer than this. (See What if my baby is still jaundiced at two weeks of age?). 
 

When should I seek help?

What if my baby is jaundiced in the first 24 hours of life?

Jaundice in the first 24 hours of life is never normal and requires urgent medical attention. Contact your midwife or GP (general practitioner) straight away.
 

What if my baby is still jaundiced at two weeks of age?

If your baby is still jaundiced two weeks after birth they need to be checked out by your GP (general practitioner) or midwife. Your baby will need to have a blood test and may then need to see a paediatrician. It is important not to miss any of the rare causes of jaundice that need special treatments. Biliary atresia is one of these important conditions.
 

What if my baby is jaundiced and has pale bowel motions?

Babies need to see a paediatrician urgently if they are jaundiced and have pale, white or light beige-coloured bowel motions (poo, stools). See the Stool colour chart at the UK Children's Liver Disease Foundation website.
 
Children with jaundice and pale bowel motions may have biliary atresia.
 
Children with biliary atresia will:
  • be jaundiced
  • have pale bowel motions
  • have dark coloured urine
  • may look otherwise well

What if my baby is jaundiced and unwell?

You should call your midwife or GP (general practitioner) urgently if your baby is jaundiced and:

  • looks sick
  • is jittery (trembling)
  • has an unusual cry
  • is becoming more obviously yellow over their whole body
  • is sleepy and slow to wake up for feeds
  • is feeding poorly
  • is getting dehydrated (dry) - signs include not wetting nappies

You should also talk to your midwife or GP if your baby:

What puts my child at risk of getting severe jaundice?

There are a number of conditions that increase the chance of your baby getting jaundiced. These include:

  • incompatibilities between the mother’s and the baby’s blood types (Rhesus disease, and ABO incompatibility)
  • some inherited conditions (G6PD deficiency, hereditary spherocytosis and others)
  • prematurity (your baby is born early)
  • infection that begins before or after birth
  • many other uncommon medical conditions such as cystic fibrosis and thyroid disorders

What is Rhesus disease?

Rhesus disease can only happen if a mother’s blood type is Rhesus negative and her baby’s blood type is Rhesus positive. The mother’s immune system produces antibodies that react against her baby’s blood. The baby’s red blood cells break down. The medical word for this process is haemolysis. It leads to more bilirubin being produced than normal and a high chance of jaundice.
 
A mother’s blood type is routinely checked at the beginning of pregnancy. All women who are Rhesus negative have extra blood tests during pregnancy to check if they are making Rhesus antibodies. The baby’s blood group is not known at this stage. It is checked after birth. If a baby is at risk of Rhesus disease, there are several treatments.
 

What is ABO incompatibility?

ABO incompatibility happens when a mother’s blood type is O, and her baby’s blood type is A or B. The mother’s immune system may react and make antibodies against her baby’s red blood cells. The consequences and treatment are similar to Rhesus disease.
 

What is G6PD deficiency?

G6PD deficiency (glucose-6-phosphate dehydrogenase deficiency) can cause jaundice at any age, including in the newborn baby. It mostly affects males. It is inherited. It is more common in babies with parents of Asian, African, or Mediterranean descent. 
 
In G6PD deficiency, red blood cells may break down (haemolyse). This leads to more bilirubin being produced than normal and a high chance of jaundice. See the Melbourne Royal Children's Hospital information on G6PD deficiency or the Nemours Foundation information on G6PD deficiency for detailed information.
 

How is jaundice diagnosed?

If your baby’s skin is yellow, and the white parts of their eyes are yellow, then your baby is jaundiced. In most newborn babies jaundice is normal and natural. 
 
Measuring bilirubin on a blood test gives more information about the level of jaundice.
 
A blood test is done:
  • if the jaundice appears before 24 hours of age
  • if your baby is very yellow
  • if the jaundice lasts more than two weeks
  • if there are other concerns

What treatments are available?

No special treatment is needed, if your baby has normal (physiological) jaundice. Breastfeeding gives your baby essential food and the right amount of water. Babies do not normally need extra water. Mild jaundice in the first week may be treated by simply making sure that your baby has enough fluid and you can do this by breastfeeding. Regular feeding to boost the supply of breast milk is important.
 
If the bilirubin level is high, the most commonly used treatment is phototherapy (bright light therapy). It does not contain ultraviolet radiation. 
 
Phototherapy is very safe and effective. Most importantly, it can prevent lasting harm to your baby.
 
Phototherapy
Phototherapy is usually done in hospital. The treatment works best when as much skin as possible is exposed to the light, so your baby is undressed. Your baby may be placed in an incubator to keep warm during the treatment. Your baby’s eyes are covered to shut out the bright light.
 
Phototherapy works by changing the bilirubin in the skin into a form that will not cause deafness or brain damage. Phototherapy is required until the level of bilirubin has dropped to a safer level (regular blood tests are needed to measure the bilirubin level). Phototherapy treatment is usually given for 48 hours, but often longer for persistently higher bilirubin levels.   
 
Usually phototherapy is the only medical treatment needed. A small number of babies with severe jaundice need blood transfusions to replace red blood cells that have been used up and to dilute out the bilirubin. 
 

Are there likely to be any complications?

Complications of jaundice in babies are rare when the correct treatment is given. Severe jaundice can lead to deafness or brain damage (kernicterus) if it is not recognised and treated quickly.
  
Points to remember about jaundice in the newborn are:
  • normal (physiological) jaundice in the newborn does not cause complications
  • breast milk jaundice does not cause any complications
  • liver disease occasionally causes prolonged jaundice
  • prolonged jaundice (over two weeks) can sometimes be a clue to another condition and should be investigated

Acknowledgements

Thank you to Babylink for allowing use of the phototherapy photo.

 

Attached Files: 
Yellow alert poster. Children's Liver Disease Foundation (UK)
Content endorsed by the Paediatric Society of New Zealand 31 March 2011
© Paediatric Society of New Zealand and Starship Foundation 2005 – 2013
Printed on 23 May 2013. Content is regularly updated so please refer to www.kidshealth.org.nz for the most up-to-date version