Jaundice In Newborns
In the first few days after childbirth, you may notice your baby’s skin has developed a yellowish tinge.
This is called jaundice, and studies have found it’s generally a benign issue which occurs in around 60% of healthy babies who are born after 38 weeks.
Jaundice is more common in babies who are born prematurely or are unwell at birth.
It usually disappears over time, and is rarely considered a problem.
But many parents do worry about it being a serious illness.
After all, the heel pricks and monitoring can make it seem like a big concern.
Is jaundice in newborns a serious health complication which new parents need to be worried about?
What Is Jaundice?
Jaundice is caused by too much bilirubin in your baby’s blood. Bilirubin is a yellow substance, which is produced when the body is breaking down old red blood cells.
While your baby is in your uterus, the placenta has the job of removing the bilirubin. After the birth, your baby’s liver takes over this function.
The newborn liver is not fully developed at birth, and it can take a few days to several weeks before it begins to function fully. During this time, your baby is recycling red blood cells, and bilirubin is being produced faster than it can be excreted.
Their skin begins to develop a yellow tinge, beginning from the face and head and often spreading downwards. This is called physiologic jaundice, because it’s part of a normal body process.
If your baby has olive or dark skin, the yellow tinge may not be as obvious. The whites of her eyes, inside the mouth, palms of the hands and soles of her feet may also turn yellow.
Other signs of jaundice to look out for are:
- Baby is very sleepy and drowsy
- Your baby might not be feeding effectively
- Urine may be dark yellow rather than colourless
- Very pale stools (faeces)
As the bilirubin levels increase, your baby’s skin will turn yellow from the head down. Jaundice is usually graded from mild (only on face and head), moderate (chest and stomach), to severe (palms and soles of feet).
What Causes Jaundice?
Babies are naturally born with high levels of red blood cells. This is because their bone marrow doesn’t begin producing red blood cells until around the fourth week after birth. These red blood cells are recycling through your baby’s body and creating bilirubin. I’s normal for bilirubin levels to increase during this time of transition, from life inside the womb to life outside.
Pathological jaundice occurs when high levels of bilirubin occur due to a number of other conditions, such as:
- Blood cells that are abnormally shaped
- Bleeding under the scalp, which has occurred during a difficult birth
- Rh (Rhesus) and ABO blood group incompatibility
- Neonatal hepatitis caused by viruses (cytomegalovirus, rubella, and hepatitis A, B and C), all of which can trigger hepatitis
- Deficiency in certain enzymes
- Higher than normal levels of red blood cells, which occurs more often in smaller babies and twins
- Premature babies are more likely to develop jaundice as their livers are immature and take longer to develop
- Some medications
- Infections such as sepsis
- Diseases such as cystic fibrosis or biliary atresia
- Low oxygen levels
- Many different genetic or inherited disorders
Does Jaundice Cause Problems?
Doctor Sarah Buckley says, “Some degree of jaundice is normal in newborn babies. We now know that bilirubin, the body chemical that causes jaundice, is a powerful antioxidant. So in healthy babies, low to moderate levels of jaundice might help protect at the important transition to life outside the womb. This means that babies who are healthy, alert and feeding well may not require phototherapy for mild jaundice.”
When jaundice occurs as a normal part of the transition from life from the womb to the world, the most likely outcome will be frustration with establishing breastfeeding. This is because jaundiced babies tend to be very sleepy, and may not nurse frequently or very effectively. Do not listen to advice involving waking up your baby by putting wet facecloths on them, or any other shock tactics. If you need breastfeeding support or advice, the most qualified professional is an IBCLC (International Board Certified Lactation Consultant). The Australian Breastfeeding Association (or La Leche League in the US) is a great start too.
Pathological jaundice, due to underlying issues, can cause problems for a small amount of babies. The brain has a protective coating called the blood-brain barrier. This barrier is wrapped around every blood vessel in the brain, protecting it from toxic chemicals. In newborns, the blood-brain barrier takes a few days to a week to start filtering out toxins.
If bilirubin levels are very high during this time, it can lead to deafness, cerebral palsy and other forms of brain damage. The difficulty is other factors can cause a baby to be more susceptible to brain damage, such as blood PH levels, or if there is enough albumin available to bind to the bilirubin.
Doctor Buckley says, “Very high levels of jaundice do need treating because bilirubin can cross into the brain and cause damage, called kernicterus.”
Most newborns who experience physiologic jaundice will not require any treatment. Symptoms normally pass in the first two weeks following birth. Sometimes babies might have symptoms for longer and this may be due to other causes, such as breastmilk jaundice (which ironically, has nothing to do with your breastmilk).
If your baby has normal physiologic jaundice, there are several things you can do to help your baby’s body clear it more efficiently:
- Frequent feeding – bilirubin is excreted by your baby’s stools. Breastmilk is an excellent laxative, and breastfed babies tend to poo more frequently, excreting bilirubin faster. All fluid intake will help to flush the bilirubin from your baby’s body.
- Window therapy – sunlight helps to break down bilirubin in the skin, so the liver can process it more easily. Ten to fifteen minutes of exposure next to a closed window four times a day is enough. Sunburn is possible, so keep an eye on the time and be sure to avoid peak sunlight.
If your baby has very high, prolonged levels of bilirubin, treatment may be needed. There are two main treatments your hospital can use to quickly reduce bilirubin levels in your baby – phototherapy and exchange infusion.
Phototherapy is most commonly used. Conventional phototherapy involves placing your baby under a halogen or fluorescent lamp, with their eyes covered to prevent damage. Fibre-optic phototherapy involves your baby being placed on a blanket of fibre-optic lights, which shines light onto your baby’s back. These blankets are sometimes available for home care.
Usually, both types of phototherapy will be stopped for half an hour every three to four hours, allowing you time to feed your baby, change their nappy and enjoy some skin to skin.
If continuous phototherapy is needed, your baby will need to be exposed to light constantly, and you may not be able to hold or feed them. You can express breastmilk, and have it provided to your baby via a feeding tube.
Your baby will be monitored to ensure they aren’t getting too hot, and they will be checked for dehydration and given intravenous fluids if needed.
Exchange infusion may be given if your baby’s bilirubin levels are very high or if phototherapy hasn’t worked. Exchange infusion is a type of blood transfusion. Small amounts of your baby’s blood is removed and replaced with blood from a matching donor. The donor blood will not contain any bilirubin, so the levels in your baby’s body will drop quickly. The process can take a few hours and your baby will be monitored constantly.
Newborn physiologic jaundice is a normal and temporary part of the process following birth. Jaundice is unlikely to become severe in babies who were born full term (37-42 weeks) and have no other medical conditions. Your doctor, midwife or maternal health nurse will monitor your baby for jaundice. If you have any concerns about your baby, you should seek medical advice as soon as possible.