Jaundice In Newborns: What's Normal And What's Not

Jaundice is a common condition in newborns, causing yellowing of the skin and eyes. It occurs when there is an excess of bilirubin, a yellow pigment of red blood cells, in the blood. While jaundice is usually harmless and often resolves without treatment, in rare cases, it can indicate a more serious underlying health issue. Therefore, it is important for parents to be informed about jaundice and know when to seek medical advice.

What is jaundice?

Jaundice is a common condition in newborns, characterised by a yellow discolouration of the skin and eyes. It occurs when there is an excess of bilirubin in the blood, which is a yellow substance produced when red blood cells are broken down.

In newborns, jaundice usually occurs because a baby's liver is not yet mature enough to efficiently remove bilirubin from the bloodstream. This is known as physiological jaundice and is a natural occurrence in newborns. It generally appears within the first few days of life and tends to resolve within two weeks, as the baby's liver matures and becomes more effective at processing bilirubin.

While jaundice is typically harmless and resolves without treatment, in rare cases, very high levels of bilirubin can lead to severe jaundice and serious complications, such as brain damage. Therefore, it is important to monitor jaundice and seek medical advice if symptoms worsen or persist beyond two weeks.

There are four main types of jaundice, categorised by the location of bilirubin build-up in the body: prehepatic, hepatic, posthepatic, and obstructive. Jaundice can be a symptom of various health problems, including infections, liver disease, gallstones, and certain medications. In adults, jaundice is rare and usually indicates an underlying condition.

What causes it?

Jaundice in newborns is caused by a build-up of bilirubin in the blood, known as hyperbilirubinaemia. Bilirubin is a yellow substance produced when red blood cells, which carry oxygen around the body, are broken down.

During pregnancy, the placenta removes bilirubin from the baby's body. After birth, the baby's liver starts doing this job. It may take some time for the baby's liver to be able to do this efficiently. A newborn baby's liver is not fully developed, so it's less effective at processing the bilirubin and removing it from the blood. This means the level of bilirubin in babies is much higher than in adults.

Newborns produce more bilirubin than adults because of the greater production and faster breakdown of red blood cells in the first few days of life. Normally, the liver filters bilirubin from the bloodstream and releases it into the intestinal tract. A newborn's immature liver often can't remove bilirubin quickly enough, causing an excess of bilirubin. Jaundice due to these normal newborn conditions is called physiologic jaundice, and it typically appears on the second or third day of life.

In some cases, an underlying disorder may cause infant jaundice. In these cases, jaundice often appears much earlier or much later than the more common form of infant jaundice. Diseases or conditions that can cause pathological jaundice include:

• An underactive thyroid gland (hypothyroidism)
• Blood group incompatibility (when the mother and baby have different blood types)
• Rhesus disease (when the mother has rhesus-negative blood and the baby has rhesus-positive blood)
• A urinary tract infection (UTI)
• Crigler-Najjar syndrome (an inherited condition that affects the enzyme responsible for processing bilirubin)
• A blockage or problem in the bile ducts and gallbladder
• An inherited enzyme deficiency known as glucose 6 phosphate dehydrogenase (G6PD)
• Internal bleeding (hemorrhage)
• An infection in the baby's blood (sepsis)
• Other viral or bacterial infections
• Biliary atresia, a condition in which the baby's bile ducts are blocked or scarred
• An enzyme deficiency
• An abnormality of the baby's red blood cells that causes them to break down rapidly
• Sickle cell anaemia
• Cephalohematoma (bleeding underneath the scalp caused by a difficult delivery)
• Cystic fibrosis or hepatitis
• Bruising during birth
• Dehydration or low caloric intake
• Low blood oxygen level (hypoxia)
• Genetic or inherited disorders

How is it treated?

Jaundice in newborns is usually harmless and often disappears without treatment within 10 to 14 days. However, in rare cases, it can be an indication of an underlying health condition. Therefore, it is important to determine whether treatment is required.

Treatment Options:

Phototherapy

If your baby requires treatment for jaundice, phototherapy is often the first line of action. This involves exposing your baby's skin to a special type of light (not sunlight) that helps break down the excess bilirubin in the skin, making it easier for the liver to process and remove it from the body.

During phototherapy, your baby will be placed under a light in a warm, enclosed bed, wearing only a diaper and eye protection. The treatment will be paused regularly to feed and change your baby and allow for cuddles.

If your baby's jaundice does not improve with standard phototherapy, intensified phototherapy may be recommended, which involves increasing the amount of light or using an additional light source, such as a light blanket.

Exchange Transfusion

If your baby's bilirubin levels remain very high or phototherapy is ineffective, an exchange transfusion may be necessary. This is a more invasive procedure where your baby's blood is removed through a thin tube (catheter) placed in their blood vessels and replaced with blood from a matching donor. Most babies respond well to this treatment and can leave the hospital after a few days.

Intravenous Immunoglobulin (IVIg)

If jaundice is caused by blood type incompatibility between the mother and baby, intravenous immunoglobulin (IVIg) may be administered through an IV. IVIg blocks the antibodies that attack the baby's red blood cells and can reduce the need for an exchange transfusion.

Intravenous Fluids

If your baby is at risk of dehydration or is unable to drink enough, intravenous fluids may be given to prevent a rise in bilirubin levels due to dehydration.

Feeding

For newborns with breastfeeding jaundice, increasing the frequency of breastfeeding or supplementing with formula can help lower the risk of jaundice. Breast-fed infants should be fed eight to 12 times a day during the first few days of life.

Monitoring and Follow-up

If your baby's jaundice is mild and does not require treatment, it is important to continue regular feeding, ensuring your baby is adequately hydrated. If your baby's condition worsens or does not improve within two weeks, contact your healthcare provider for further assessment and advice.

When to Seek Medical Help:

• If your baby's skin and eyes become more yellow
• If your baby seems listless, sick, or difficult to awaken
• If your baby is not gaining weight or is feeding poorly
• If your baby makes high-pitched cries
• If your baby develops any other concerning symptoms

How common is it?

Jaundice is very common in newborn babies. About six out of ten newborns have jaundice to varying degrees, with sources giving specific estimates of up to 60% for full-term babies and 80% for premature babies.

Jaundice is caused by a buildup of bilirubin in a newborn's blood. Bilirubin is a yellow substance that is created when the body breaks down old red blood cells. During pregnancy, the mother's placenta removes bilirubin from the baby's body. After birth, the baby's liver takes over this role, but it may take a few days for the liver to be able to do this efficiently.

Jaundice usually appears on the second or third day after birth and typically lasts about one to two weeks. In babies who are breastfed, it can last longer.

While jaundice is usually not serious, it is important for a healthcare provider to check the baby for jaundice. In rare cases, severe jaundice can lead to serious health complications such as brain damage if left untreated.

How to identify it?

How to identify jaundice in newborns

Jaundice in newborns is a common condition, usually harmless, and often goes away without treatment. It is caused by a high level of bilirubin in the blood, which is a yellow substance produced when red blood cells are broken down.

How to identify it:

• The yellowing of the skin and the whites of the eyes is the main sign of jaundice. This can be more difficult to see in babies with brown or black skin, but may be more obvious on the palms, soles of the feet, or the head and face.
• To check, gently press the skin on your baby's nose or forehead. If the skin appears yellow when you lift your finger, it is likely your baby has mild jaundice.
• Other symptoms include dark yellow urine (which should be colourless) and pale-coloured poo (which should be yellow or orange).
• Jaundice usually appears about 2 days after birth and disappears by the time the baby is 2 weeks old. In premature babies, it can take 5-7 days to appear and lasts about 3 weeks.
• Jaundice is more common in preterm babies and those who are breastfed.
• If you are concerned, contact your midwife, health visitor or GP as soon as possible.

Frequently asked questions