Jaundice is a very common condition that happens to babies. It’s a condition that causes a yellowish tinge to appear on the skin and sometimes the whites of the eyes.
Usually, jaundice is harmless and disappears after 1 to 2 weeks.
However, sometimes jaundice can be more serious and require treatment
Please read on to discover more about what causes jaundice and the treatments available.
Jaundice in newborns
Around 60% of full-term and 80% of premature newborn babies develop jaundice in the first month after birth.
In very rare instances, infants who have jaundice might need intensive treatment.
As so many babies experience it, it’s safe to say jaundice is mostly a natural part of the process of transition from womb to world.
There are several types of jaundice that develop in babies:
Physiological jaundice, or transient jaundice, occurs normally as a result of a high concentration of red blood cells and immature liver function. This means it’s not caused by a disease or functional problem.
Pathological jaundice is when high bilirubin levels occur in the first 24 hours after birth or if the bilirubin level is very high from the first 24 hours to 10 days after birth. This typeof jaundice is generally causing by a disease or condition.
Breastfeeding jaundice occurs 5-7 days after birth, typically peaks at 14 days and can last as long as a few months. It’s thought to be caused by an increased concentration of an enzyme (beta-glucuronidase) found in breast milk. Breast milk jaundice is common in breastfed babies and is normal.
What causes jaundice in the newborn?
Jaundice isn’t a disease or infection. Newborn jaundice is caused by a buildup of bilirubin – the yellow substance produced when the body breaks down old red blood cells.
In the uterus, the placenta is responsible for this process. After birth, the baby’s liver takes over.
In newborns, however, it takes about two weeks for the liver to do this, which is unusual since all other systems make a pretty much instantaneous transition at birth. There is some research that suggests bilirubin has a protective effect against the sudden high levels of oxygenated blood after birth.
Infant jaundice could be caused by an underlying disorder. The majority of infants born between 35 weeks and full-term do not need treatment for jaundice.
Another possibility is when a baby’s blood type isn’t compatible with the mother’s, antibodies can form. They can damage the baby’s red blood cells and cause a rise in bilirubin levels.
Other causes of newborn jaundice include:
- Bruising or internal bleeding
- Liver disorders
- An infection
- Enzyme deficiency
- Abnormalities in a baby’s red blood cells
You might be interested in reading Jaundice In Newborns – The Truth About Jaundice.
Symptoms of jaundice in newborns
The typical symptoms of infant jaundice are yellowing of the baby’s skin and whites of the eyes. Usually, the yellowing starts from the head and face and moves down the body as levels of bilirubin rise.
Babies who have mild or physiological jaundice will generally have yellow skin and eyes and can be a little sleepier.
If jaundice becomes severe or is pathological, babies might have increasing yellowness, seem very lethargic and might not wake to feed.
If your baby’s jaundice is becoming more pronounced, if she isn’t feeding or losing weight, or her stools are very pale and urine is very dark, seek medical advice from your doctor.
What color is jaundice poop?
Bilirubin is a yellow substance formed through the breaking down of red blood cells.
The liver filters bilirubin from the blood and is then excreted in the urine and stool. It’s what gives urine a yellow color. Broken down and combined with what’s been digested, bilirubin makes poop brown in color.
Your baby’s first poop, meconium, will be the classic black-green color. As milk goes through the baby’s system, the stool color will change, becoming more mustard yellow or darker. Urine should be light yellow in color.
Whitish or pale poop can indicate a more serious problem with the liver and needs immediate medical assessment.
How is newborn jaundice diagnosed?
It is important we correctly diagnose the underlying cause of jaundice. Your midwife or doctor will assess your baby’s jaundice, using this methods :
- Physical examination (always)
- Skin reading of jaundice levels (often)
- Blood test or bilirubin test, to measure the level of bilirubin in the red blood cells (sometimes). If there is a high amount of unconjugated bilirubin, compared with conjugated bilirubin, one would expect hemolytic jaundice or hemolytic disease of the newborn (HDN)
- Imaging tests, liver biopsy, or exploratory surgery (rarely).
You will be able to speak with your midwife, doctor or pediatrician before making any decisions.
Newborn jaundice bilirubin levels
Elevated levels of bilirubin might show different types of jaundice or liver disease. There are different levels to determine whether the jaundice is normal or something to be concerned about.
Here are the different infant jaundice levels used around the world:
Serum bilirubin levels, by age of baby (hours old): bilirubin measurement (micromole/liter)
Less than 24 hrs: above 180
24-48 hrs: above 270
49-72 hrs: above 324
More than 72 hrs: above 360
Serum bilirubin levels, by age of baby (hours old): bilirubin measurement (micromole/litre)
Less than 24hrs: above 200
24-48hrs: above 260
49- 72hrs: above 320
More than 72hrs: above 350
Serum bilirubin levels, by age of baby (hours old): bilirubin measurement (micromole/litre)
6hrs: above 125
12hrs: above 150
18hrs: above 175
24hrs: above 200
You can read more about jaundice in Bilirubin Levels In Newborns – What’s Normal?
How is newborn jaundice treated?
Treatment for newborn jaundice depends on what is causing it and the symptoms your baby has.
If your baby develop jaundices, treatments might include:
- Enhanced nutrition. It’s recommended you breastfeed frequently (or supplement feed if necessary) to ensure your baby gets adequate nutrition and gains weight. This also helps your baby eliminate and process bilirubin
- Light therapy (phototherapy). Your baby is placed under a special lamp that emits light in the blue-green spectrum. The light changes the shape and structure of bilirubin molecules so they’re moved out more easily
- Intravenous immunoglobulin (IVIg). When the mother’s and the baby’s blood groups are incompatible, this can mean the baby’s red blood cells are quickly broken down
- Exchange transfusion. Rarely, severe jaundice doesn’t respond to other treatments and infants might need a blood transfusion. This involves repeatedly withdrawing small amounts of the baby’s blood and replacing it with donor blood, diluting the level of bilirubin and the maternal antibodies.
How long does jaundice last in the newborn?
How long jaundice lasts depends on whether it’s physiological or pathological.
Physiological usually appears in the first week of life and resolves in 1-2 weeks (3 weeks if the baby is premature).
Pathological jaundice might last longer and require treatment until the baby’s liver filters the bilirubin and the level of bilirubin is back to normal.
Does breast milk help with jaundice?
One of the treatments for jaundice is plenty of breast milk, to flush the excess bilirubin through the body.
It used to be common to suggest supplement feeds but this is no longer recommended unless there’s a medical reason why the baby can’t have breast milk. Demand feeding will help boost milk supply and ensure the baby is getting plenty of nutrition too.
How often should a jaundiced baby be fed?
Skin to skin helps to encourage the baby to feed often. This also helps with bonding and fostering a good microbe environment for the baby, as well as boosting milk supply.
If your newborn only has slight jaundice then you might just demand feed (when baby want to feed) and wake her every three hours if she doesn’t wake for feeds.
If your newborn has a more severe case of jaundice, she might need to be tube fed (via a tube in the nose) every few hours, if she’s too weak to suck and feed herself.
Breast milk is always best for baby. You can express and feed baby via the tube, aiming for a few feeds directly at the breast as baby’s jaundice improves.
Formula feeding shouldn’t be routinely recommended as this can interrupt the establishment of breastfeeding.
Expressing during pregnancy and keeping colostrum for feeds after birth can also be used to help pass the bilirubin.
If this is not enough and baby is not responding to phototherapy or other treatments and losing large amounts of weight, then formula feeding might be recommended.
Does sunlight help newborn jaundice?
You might be told to pop baby near a window and let the sunlight do the work of getting rid of jaundice. This was certainly the advice given to mothers in past generations and the origins of phototherapy for jaundice.
Indirect or filtered sunlight can help your baby process mild jaundice. Be careful not to put your baby in direct sunlight as this will cause sunburn and overheat baby.
A great idea is to put baby in a nappy, and pace her in indirect sunlight while she sleeps. Most babies love this.
Does vitamin D help with newborn jaundice?
This study concluded newborn vitamin D levels were significantly lower in jaundiced babies compared with healthy non-jaundiced babies. It suggests newborns with lower vitamin D levels are at higher risk for developing hyperbilirubinemia.
Vitamin D is usually recommended as a prenatal supplement, due to the increased risk of pregnancy complications if you’re low in Vitamin D. Complications include preeclampsia, diabetes, and preterm birth.
Babies born with vitamin D deficiency might have problems with their bones growing. In extreme cases, they could develop flexible bones (rickets).
You might like to read more in BellyBelly’s article Why Vitamin D Is So Important.
Do jaundiced babies sleep more?
Babies who can’t get enough milk can become dehydrated, fail to gain or lose weight and might be very sleepy.
They just don’t have the energy required to be alert and awake to feed and will want to sleep more. They might also find it difficult to latch and have a poor suck reflex at the breast.
Do babies with jaundice cry a lot?
In fact, babies who develop jaundice are mostly very tired. Their little bodies are working overtime processing bilirubin.
If your baby is crying, active and feeding, with good amounts of wet and pooey nappies, then all is well.
You will learn to distinguish your baby’s crying. This is how they communicate initially if they are hungry or having pains.
When should I be concerned about my newborn’s jaundice?
As parents and even while we’re pregnant we get the feeling that something is not quite right; it’s mother’s intuition.
You should be concerned if:
- Your baby is very lethargic and not waking for feeds
- Your baby has more than just facial yellowing, and you have noticed the yellow color is spreading down the body, the skin and the whites of the eyes
- You have noticed that your baby has fewer wet and pooey nappies.
How serious is jaundice in a newborn?
Normal jaundice in babies isn’t serious and could even have a protective effect. Very high levels of bilirubin are usually due to something rare, such as liver disease or a blocked bile duct (biliary atresia) which can cause liver failure.
Very rarely, high jaundice levels can have damaging effects on your baby’s brain (kernicterus). This can cause permanent brain damage.
How to prevent jaundice in newborns?
The only type of jaundice that can be prevented is caused by an incompatible blood type. If this is suspected, mothers will be offered an anti-D injection after birth to prevent complications in subsequent pregnancies.