Jaundice in newborn infants

What is jaundice?

Jaundice is the yellowing of the whites of the eyes and skin. It is very common in newborn babies.

How can I tell if my baby has jaundice?

You can tell if your child has jaundice by looking at the white part of the eyes. The gums and tongue can also look yellow. You could also press gently over the skin of the forehead, or nose and release. If the skin looks yellow over the area you have pressed your baby has jaundice. Examine your baby under good lighting ( preferably daylight)

What causes jaundice?

Jaundice develops when bilirubin accumulates in the blood. Bilirubin is a yellow pigment that is released when red blood cells are broken down in the body. Bilirubin is removed from the body by the liver and is shed out through the stool and urine. Jaundice develops when bilirubin is produced at a faster rate than it is removed from the body. Newborns commonly develop jaundice because they breakdown red blood cells faster and the liver is not yet mature enough to remove the bilirubin fast enough.

A common cause of jaundice which most newborns have is caused by mild to moderate increase in bilirubin levels and is not usually harmful to infants. The jaundice is usually noticed around the third day of birth and usually goes away by one to two weeks. This is called physiologic jaundice.

New born babies can have jaundice due to underlying problems. These may include:

  • Internal bleeding due to bruising and injury during birth.
  • If the mother’s blood and the baby’s blood are not compatible a reaction may occur that leads to breaking down of the baby’s red blood cells.
  • The baby may be born with an abnormality in the red blood cells that causes them to be broken down at a faster rate.
  • Jaundice may occur in a baby who does not take in enough breastmilk. This can happen if the baby has breastfeeding difficulties or when the mother is not producing enough breastmilk.
  • Breastfeeding babies with  immature liver and intestines may not remove bilirubin fast enough leading to jaundice.
  • Babies may develop jaundice if they have an infection. Sepsis is a type of infection in the child’s blood that can be life threatening if not treated promptly.
  • Babies born before 38 weeks (premature babies) are more likely to develop jaundice because their bodies are not yet mature enough to process bilirubin. They also feed less and have fewer bowel movements and so do not remove bilirubin from the body as well as older babies.
  • Problems of the liver or liver enzymes can cause jaundice in newborns. 

What are the symptoms of jaundice?

The first symptom of jaundice is a yellowing of the baby’s eyes or skin. The yellowing may spread downwards from the head to the feet as it gets more intense.

Is there a test for jaundice?

It’ is important to bring your baby in for a checkup a few days after birth because bilirubin levels peak between day 3 and day 7 of age. Your doctor will be able to tell that your baby has jaundice by how he/she appears. It will be necessary to measure the level of bilirubin in the baby’s blood. The level of bilirubin will determine how the baby will be treated.

Additional tests may be needed if the jaundice is suspected to be caused by other underlying problems.

Is there anything I can do on my own to help the jaundice get better?

Yes. To help your baby’s jaundice get better make sure the baby breastfeeds often and in the right way. If your baby is taking formula make sure it is enough. A bay who is drinking enough will have a wet diaper at least once every 4 hours. They will look satisfied and content and the poop will change colour from dark green to yellow.

How is jaundice treated?

Mild jaundice will often get better on it’s own within 2 or 3 weeks. If the bilirubin levels are higher than a certain level treatment to will be needed. Treatment to lower bilirubin levels in blood include:

Light therapy ( or phototherapy). The baby will be placed under a special light that alters the bilirubin molecules in such a way that they can be shed in the urine and stool. During treatment, your baby will wear only a diaper and patches over the eyes to protect them.

Exchange transfusion. This involves repeatedly withdrawing small amounts of bilirubin containing blood from the baby and replacing it with donor blood. This is done when the bilirubin levels are very high.

What are the complications of jaundice?

High levels of bilirubin or severe jaundice can cause serious problems if not treated.

Bilirubin may get into the brain and cause damage. Initially it may be reversible,a condition called acute bilirubin encephalopathy. You may notice the following problems if the baby develops this condition: The baby may be weak and less responsive; the child will suck or feed poorly; the baby will have a high pitched cry; there may be backward arching of the neck and body; the child may develop a fever.
High levels of bilirubin in the blood may also lead to permanent damage to the brain. This is a condition called kernicterus (or chronic bilirubin encephalopathy). It may result in Involuntary and uncontrolled movements, eye permanently looking upwards, hearing difficulties and problems with development of teeth.

When should I call my doctor or nurse?

Contact your healthcare provider if you notice the following symptoms:

  • The jaundice spreads to the abdomen,arms and legs or becomes deeper.
  • Your baby develops a fever (or temperature above 38°C)
  • Your baby feeds poorly, appears weak or lethargic, or becomes unusually irritable.
  • Has a stiff, limp, or floppy body.
  • Has strange eye movements.
  • Your baby develops any problems that worry you.

Early diagnosis and treatment of jaundice will help prevent injury to the brain. If you’re concerned that your baby might have jaundice visit your doctor and have the baby evaluated.

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