Key points to remember about jaundice in babies

• jaundice means yellow colouring of the skin and the whites of the eyes
• mild jaundice is common in newborn babies - it starts on the second or third day and settles over 7 to 10 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 needs checking by a doctor straightaway
• jaundice at any age with pale poos and dark wee needs checking with a blood test
• jaundice still there after 2 weeks of age needs checking by a doctor
• 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.

Why do babies get jaundiced?

Jaundice is very common - over half of all babies have it.

At low or medium levels, jaundice does not cause problems. But bilirubin, the substance causing the jaundice, can be harmful at high levels. It can lead to deafness or brain damage. Babies with high levels need immediate treatment.

In most babies, jaundice is normal and natural and settles as the baby's organs mature and adjust after birth.

The medical term for this type of jaundice in newborns is physiological jaundice. This type of jaundice does not usually harm babies.

Some breastfed babies may stay jaundiced for longer than formula-fed babies. This is because of a normal and natural effect of breastmilk on babies. This type of jaundice is called breastmilk jaundice. It is not harmful.

There are many other reasons for jaundice and if you are concerned, you should talk to your midwife or your family doctor.

Each year in New Zealand, a small number of babies are born with liver disease which also causes jaundice. This is not normal and your doctor or midwife needs to see this.

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 after birth
• wakes up of their own accord to demand feeds
• looks well and feeds well
• has dirty nappies (poo) that are yellow or green (not pale, white or light beige) in colour
• has wee which is clear or straw-coloured, not yellow or dark

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 my baby's jaundice last?

Normal (physiological) jaundice usually fades away after 1 or 2 weeks. Sometimes normal jaundice may last longer than this.

When should I seek help for my baby's jaundice?

Depending on which of the following applies to your baby, check the matching section below:

• jaundice which started in the first 24 hours after birth
• jaundice lasting more than 2 weeks
• your baby is jaundiced and has pale poo
• your baby is unwell or is becoming increasingly yellow

What if my baby is jaundiced in the first 24 hours after birth?

Jaundice in the first 24 hours after birth is never normal and needs urgent medical attention. Contact your midwife or doctor straightaway.

What if my baby is still jaundiced at 2 weeks of age?

If your baby is still jaundiced 2 weeks after birth, your doctor or midwife will need to check them. Your baby will need a blood test and may need to see a paediatrician (a doctor specialising in babies and children).

It is important not to miss any of the rare causes of jaundice that need special treatments. Biliary atresia [1] is one of these important conditions.

What if my baby is jaundiced and has pale poos or dark wee?

If your baby is jaundiced and has pale, white or light beige-coloured poo, take them to your family doctor. Your doctor can arrange an urgent appointment with a paediatrician.

See the 'Beware yellow' poster (PDF, 259KB) [2]. The poster is also available in Mandarin, (PDF, 1.22MB) [3]; Māori (PDF, 921KB) [4]; Samoan (PDF, 877KB) [5] and Tongan (PDF, 821KB) [6].

[2]

What if my baby is jaundiced and unwell?

You should call your midwife or family doctor 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 doctor if your baby:

• has not passed meconium (the first black bowel motion) by the second day
• is at increased risk of severe jaundice

What puts my baby 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 your blood type and your baby's blood type (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

See more information about Rhesus disease [7], ABO incompatibility [8] and G6PD deficiency [9].

How do doctors diagnose jaundice?

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.

A blood test gives more information about the level of jaundice.

Doctors will arrange a blood test if:

• the jaundice appears before 24 hours of age
• your baby is very yellow
• the jaundice lasts more than 2 weeks
• your baby has pale poo or dark wee
• there are other concerns

What treatments are available for jaundice?

Your baby will not need any special treatment if they have normal (physiological) jaundice. You can treat mild jaundice in the first week by simply making sure that your baby has enough fluid and you can do this by breastfeeding. Breastfeeding gives your baby essential food and the right amount of water. Babies do not normally need extra water. Regular feeding to boost the supply of breastmilk is important.

If the bilirubin level is high, the most commonly used treatment is phototherapy (bright light therapy). It does not contain rays that would harm your baby. Phototherapy is very safe and effective and can only happen in hospital. See Phototherapy [10].

A small number of babies with severe jaundice may have liver disease. Your baby may need blood tests or to go to hospital for tests, especially if the jaundice does not go away by 2 weeks of age or your baby has pale poo or dark wee.

Are there likely to be any complications from jaundice?

When babies receive the correct treatment, complications of jaundice are rare. Severe jaundice can lead to deafness or brain damage without diagnosis and quick treatment.

Points to remember about jaundice in newborn babies are:

• 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 needs checking by a doctor straightaway
• jaundice at any age with pale poo and dark wee needs checking with a blood test immediately
• jaundice still there after 2 weeks of age needs checking by a doctor
• severe jaundice can be serious - with correct early treatment long-term problems are rare