What is Jaundice?
Most jaundice is called ‘physiological’ jaundice. This condition is the result of an excess of the yellow-coloured chemical bilirubin (24, 25), which circulates through the baby’s system, giving the skin a yellow tinge. Before a baby is born, its red blood cells contain a compound called ‘foetal haemoglobin’.
This compound is different from haemoglobin after birth. It can pick up more oxygen than the variety required outside the uterus. This difference helps your baby grow and thrive in the womb – a naturally low oxygen environment. After birth, this extra oxygen pickup is no longer needed. Their red blood cells break down, and the baby creates new ones containing the haemoglobin we need on the outside.
Bilirubin is a waste product from the breakdown of old red blood cells, and the liver plays a vital role in eliminating it from the body through your baby’s bowel motions (24). Sometimes, however, a newborns liver takes a little longer to catch up with the breakdown, and jaundice can occur (25). It’s important to know that while every baby has elevated bilirubin, not all babies will show the signs of jaundice (25).
Are there other causes for jaundice?
Mild jaundice is usually ‘physiological’. This term means it is part of a baby’s healthy adjustment. However, there are known associations between jaundice and events in the first few days, including:
- Physiological Jaundice – after birth, you may produce only small amounts of colostrum. Sometimes, while waiting for the milk to come in, the fluid intake for your baby is limited. This limitation can affect the ability of your baby’s liver to eliminate waste products. This imbalance usually corrects itself once your milk comes in and baby can tolerate full breastfeeds. It’s important to feed regularly (on demand, but no longer than 3 hours between feeds when your baby has breastmilk jaundice) (24).
- Neonatal Hepatitis – exposure to some viral infections in the womb or the first month of life can trigger neonatal hepatitis (24).
- Blood group incompatibility – during the later weeks of pregnancy, your blood may produce antibodies. These can attack your baby’s red blood cells. This disorder results in the baby’s liver working harder to clear the red blood cell waste. These babies may be born with anaemia or develop severe jaundice shortly after birth (24). Therefore, it is essential to have your antenatal visits and check-ups. When we know your blood type and antibodies, we can anticipate this and act quickly to help your baby. This illness is most common in babies of mothers with O positive (O+) and Rh-negative blood types (A-, B-, O-, AB-).
Most of the time, it is quite easy to spot a jaundiced baby from his yellowing skin and eyes (for most midwives and health workers) (24). From there, we look for some other symptoms which can indicate the severity, including:
- lethargy (really sleepy, floppy babies, that are hard to wake up),
- not feeding well,
- reduced output of urine and bowel motions
- an extremely agitated baby.
We will look at your baby’s risk factors to determine which jaundice he might have. Then we will most commonly use a screening tool called a trans-cutaneous bilimetre (TCB). These work by directing light at the skin and measuring the wavelengths returned. The machine will work out an average from light measures. We plot these results on a chart and used to determine whether your baby requires further investigation. These levels depend on your baby’s gestation at birth, how many hours old he or she is and how high the reading is (26).
If this result is high, the next step would be a formal blood test (called a serum bilirubin reading or SBR). This tool measures the level of bilirubin in your baby’s blood, which we take via a heel prick and sent to pathology. Usually, the results are back quite quickly, and your doctor should have an answer for you within a few hours (24).
How is it treated?
- Mild Jaundice: For most babies, jaundice is self-limiting, and once the liver catches up, any yellowness will slowly correct itself. You can aid this by keeping up with regular feeding, so baby doesn’t get dehydrated. Once jaundice passes, you will find that baby ‘wakes up’ more and is alert and demanding feeds, rather than relying on you waking them for each feed (24).
- Moderate Jaundice: Most cases of moderate jaundice require phototherapy. Phototherapy is the use of a special UV light on your baby’s bare skin. This light breaks down the bilirubin into a form your baby’s liver can process and eliminate. This treatment means we place your baby in a warm, see-through box in just a nappy, with his eyes covered with a special blindfold. Another option is a ‘biliblanket’. This treatment is similar; however, we wrap the baby in a blanket which contains the same lights as the box. Treatment can be anywhere from a few hours, to one or two days, but your baby can stay at your bedside. Baby will still need you for regular feeding and cares (24).
- Severe Jaundice: In severe jaundice, the first line of treatment is nearly always phototherapy, however in rare cases, a blood transfusion may need to occur (24).
For more than half of babies, jaundice is a normal part of their early newborn life. If your baby is looking yellow, is lethargic, not feeding well or not filling nappies please speak to a health professional. The treatment and management of jaundice are more effective if caught early. Early advice, support and treatment will see your baby make a full recovery.
Nikki-Lee Rossiter (BMid), Registered Midwife.
Photo by Stefan Dinse used under license from Shutterstock.com