Jaundice in babies
It can sound and look alarming, but jaundice is very common among newborns – in fact, your baby is marginally more likely to develop it than not – and the vast majority of cases clear up without treatment within a couple of weeks. Still, it can be worrying when your baby becomes unwell so soon and, in a small number of cases, medical treatment is required to prevent complications.
What is jaundice?
The word sounds alarming and the yellowing of the baby's skin and whites of the eyes – which is one of the main symptoms – looks unpleasant, but it's actually very common in newborn babies. It usually develops a few days after birth, which is why it's also called neonatal jaundice and clears up within a fortnight. For premature babies, it might take a little longer to go away – about three weeks.
What are the causes?
Newborns have a high number of red blood cells, which are broken down and replaced frequently. At only a few days old, the liver is not sufficiently developed to filter out the bilirubin in the baby's blood. Bilirubin is a yellow substance which is why, when there's a build up of it in the blood, your baby goes yellow. A newborn has about twice the levels of bilirubin in their blood as an adult, which is why they are prone to falling ill with the condition.
It tends to go away after about a fortnight, when your baby's liver has developed enough to see off the bilirubin. If so, there should be no further problems and your baby will make a full recovery.
NICE guidelines detail the bilirubin thresholds that dictate at what stage and how your baby will be treated, from birth to 96 hours and beyond.
What are the symptoms?
The tell-tale yellowing of the skin is the main symptom. It usually starts on the face and head, then spreads to the chest and stomach, and possibly the legs and arms. It can be harder to spot in babies with darker skin, so parents should check for yellowing on the soles of the baby's feet, palms of her hands and inside her mouth.
Parents should also look out for the following symptoms:
- Yellowing of the whites of the eyes
- Problems feeding
- High-pitched crying
- Dark urine
- Pale poo
When to seek medical advice
Your baby will be checked during their newborn physical examination, which takes place within 72 hours of birth. It can take longer than that to develop – a week in some cases – so look out for it after you've taken your baby home.
If your baby is displaying symptoms after 72 hours from birth, or once you have brought your baby home, speak to your GP, midwife or health visitor as soon as possible.
Although it isn't usually a great cause for concern, it is important to speak to a medical professional so they can determine whether your baby needs treatment.
How common is jaundice in newborns?
Physiologic jaundice in babies, to use its official name, is common and, in the vast majority of cases, fairly harmless. Six out of 10 babies suffer from it and, among babies born prematurely, the ratio is eight out of 10. One in 20 cases requires treatment from a doctor.
Which babies are more likely to develop jaundice that needs treatment?
According to the NICE guidelines, the following babies are more likely to develop jaundice that needs treatment:
- babies who were born early (at less than 38 weeks of pregnancy)
- babies who have a brother or sister who had jaundice that needed treatment as a baby
- babies whose mother intends to breastfeed exclusively
- babies who have signs of jaundice in the first 24 hours after birth
Whether your baby looks jaundiced or not, the doctor or midwife should check whether your baby is at risk of developing high levels of jaundice soon after birth, and if so, the doctor or midwife should give your baby an additional check for jaundice during the first 48 hours.
Can I still breastfeed?
Yes. There is some evidence that breastfeeding increases the likelihood of your baby developing jaundice, although doctors aren't sure why this is. It can also take longer to clear up in breastfed babies. However, the benefits of breastfeeding far outweigh any of the risks, so if you're already breastfeeding, do carry on.
NHS Choices advises that you speak to your midwife or doctor if you think your baby has developed the illness. Treatment will only be necessary if your baby's bilirubin levels are particularly high, so they needed to be tested for that. The likelihood is that your baby's bilirubin levels will be low enough to not require treatment, and the test will help to reassure you that your baby isn't in danger. Remember – only one in 20 cases need treatment from a doctor.
According to the NHS: “While jaundice isn't usually a cause for concern, it's important to determine whether your baby needs treatment. If you're monitoring your baby's jaundice at home, it's also important to contact your midwife straight away if your baby's symptoms quickly get worse or they become very reluctant to feed.”
Testing for jaundice
Bilirubin test. The most commonly used test. A bilirubinometer will shine light on to your baby's skin. The way the light reflects off the skin will reveal your baby's bilirubin levels. However, if your baby develops jaundice within 24 hours of birth, or her bilirubin levels are particularly high, the doctor might use a…
Blood test. The doctor will take a blood sample by pricking your baby's heel with a needle (this shouldn't cause your baby pain or distress). Her bilirubin levels can then be measured from the sample.
Further blood tests will be required if the symptoms are prolonged. The doctor will want to find out whether there's an underlying cause for your baby's high levels of bilirubin, so will test for:
- Enzyme deficiency – cells need enzymes to function and survive
- The number of cells in your baby's blood
- Your baby's blood group
- Antibodies – these proteins fight infection and should be attached to your baby's red blood cells
If tests reveal underlying problems then your baby may be admitted to hospital where doctors will try to reduce the risk of kernicterus – a rare complication which can cause brain damage. The following treatments might sound unpleasant but failure to get proper treatment increases the risk of kernicterus. Remember, only a very small percentage of cases reach this point.
Phototherapy. This is used to reduce your baby's bilirubin levels. It involves photo-oxidation, the process of adding oxygen to the bilirubin, which makes it easier for the liver to break it down. With the most common form of phototherapy, your baby will lie under a halogen light with her eyes covered. This is what Mumsnetters mean when they talk about their baby lying on a “billy bed”.
Alternatively, if the doctors opt for fibreoptic phototherapy, your baby will lie on a blanket that incorporates fibreoptic cables which shine light on her back.My daughter's jaundice was diagnosed before we'd been discharged. The doctors gave her phototherapy for a couple of days and it cleared up. Once home, I was told to put her in the Moses basket by the window to make sure she got enough sunlight.
Therapy will continue until your baby's bilirubin falls to a safe level. This can take a couple of days of continuous treatment, but phototherapy will be paused every three or four hours so that you can feed, change and comfort your baby. Doctors will make sure your baby doesn't get dehydrated or too hot during phototherapy. It sounds like a distressing process but it is the most effective way of reducing bilirubin levels and shouldn't cause side-effects.
Blood transfusion might be used if your baby has not responded to phototherapy. It will involve removing small amounts of your baby's blood, via a tube, and replacing it with blood from a suitable donor. This will quickly stabilise your baby's bilirubin levels.
IVIG (intravenous immunoglobulin). This might be used if rhesus disease – which comes about if you have rhesus-negative blood and your baby has rhesus-positive blood – is found to be the underlying cause of jaundice.
Can it come back?
It shouldn't but, depending on the severity of the case, your paediatrician will monitor your baby's bilirubin levels. If you're concerned then don't hesitate to get your baby checked out again. As ever, it's better to be safe than sorry, and it's important for new parents to have peace of mind.
What Mumsnetters say
“My son had a mild case and he went more yellow after being discharged, so I rang the midwives in a blind panic. They were relieved that he didn't look too jaundiced to them, although to me he looked bright yellow. It cleared up soon after. If you're worried about your baby, it's worth getting them checked for your own peace of mind.”
“My daughter had really high bilirubin levels although her skin was not particularly yellow. She spent one day in intensive phototherapy and was fine after that.”
“It's usually not serious at all, but it is always worth getting it checked as the consequences can be very serious. My son is fine now, but it was very scary when we were being told we would have to wait and see about brain damage. They struggled to get his bilirubin levels down.”
“My son had a bit of a jaundice tan and one midwife said he would need a blood test to check his bilirubin levels. However, the midwife who visited the next day said he was perfectly fine. I then became totally paranoid and took him to the doctor who said he was fine. I would ring the doctor to put your own mind at rest.”
“Untreated, it can be very serious. The colour builds up on the body, with the face the last place to yellow. If her eyes are discoloured then get her checked by the doctors. You shouldn't wait and see.”