Caring for your newborn baby with jaundice

Newborn Jaundice

Many of us have seen a jaundiced baby with a slight yellowish tinge to the skin in those early weeks. But what is jaundice? What can we do to help reduce jaundice? And when do we need to seek medical advice??

What is Jaundice?                                                                         

Jaundice is caused by the build-up of bilirubin in the blood. Bilirubin is a yellow substance produced when red blood cells are broken down. Jaundice is common in newborn babies because babies have a high level of red blood cells in their blood, which are broken down and replaced frequently. The liver in newborn babies is also not fully developed, so it's less effective at removing the bilirubin from the blood. By the time a baby is about two weeks old, their liver is more effective at processing bilirubin, so jaundice often corrects itself by this age without causing any harm. Of course the amount of bilirubin dictates how yellow/orange your baby is and the higher the level the more noticeable the effects. 

Symptoms of jaundice

Physiological Jaundice; occurs naturally 2 to 4 days after birth. It can last up to 2 weeks.

Skin begins to develop a yellow tinge; beginning from the face and head and often spreading downwards. 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.

·         Urine may be dark yellow rather than colourless

·         Pale coloured poo

Pathological jaundice: In a small number of cases, jaundice can be the sign of an underlying health condition. This is often the case if jaundice develops shortly after birth (within the first 24 hours).

How common is it?

Jaundice is one of the most common conditions that can affect newborn babies. It's estimated 6 out of every 10 babies develop jaundice, including 8 out of 10 babies born prematurely (babies born before the 37th week of pregnancy). However, only around 1 in 20 babies has a blood bilirubin level high enough to need treatment. For reasons that are unclear, breastfeeding a baby increases the risk of them developing jaundice, which can often persist for a month or longer, known as breastmilk jaundice! In most cases, the benefits of breastfeeding far outweigh any risks associated with jaundice.

 When to seek medical advice

Your baby will be examined for signs of jaundice within 72 hours of being born, during the newborn physical examination. If your baby develops signs of jaundice after this time, speak to your midwife, Public Health Nurse or GP as soon as possible for advice. While jaundice isn't usually a cause for concern, it's important to determine whether your baby needs treatment.

If your baby has jaundice when you come home, it's also important to contact your Gp urgently if their symptoms quickly get worse or your baby;

·         becomes very sleepy,

·         becomes very reluctant to feed,

·         is difficult to rouse for feeds

·         or the jaundice is getting more yellow and travelling down the body

Treating newborn jaundice

Most cases of jaundice in babies don't need treatment as the symptoms normally pass within 10 to 14 days, although symptoms can last longer in a minority of cases. 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.

Treating more severe or pathological jaundice

Treatment is usually only recommended if tests show a baby has very high levels of bilirubin in their blood. This is because there is a small risk that the bilirubin could pass into the brain and cause brain damage.

There are two main treatments that can be carried out in hospital to quickly reduce your baby's bilirubin levels. These are:

·         phototherapy – a special type of light shines on the skin, which alters the bilirubin into a form that can be more easily broken down by the liver

·         an exchange transfusion – a type of blood transfusion where a small amount of your baby's blood is removed and replaced with blood from a matching donor

Most babies respond well to treatment and can leave hospital after a few days.

Complications

If a baby has very high levels of bilirubin, which isn't treated, there's a risk they could develop permanent brain damage. This is known as kernicterus.

Kernicterus is very rare in the UK, affecting less than 1 in every 100,000 babies born. (NHS 2015)