Jaundice in Newborn Babies
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What is jaundice?
Jaundice is the name given to the yellowing of the skin and the whites of the eyes in newborn babies. Jaundice is very common, usually harmless and clears up on its own after 10–14 days in the majority of newborns. For some babies this may continue beyond 14 days and this is known as prolonged jaundice. Newborn babies produce large quantities of the pigment bilirubin. This is the
substance that gives the yellow colour to the skin and whites of the eyes. Bilirubin forms after the red blood cells break down. It is normally processed by the liver and passed out of the body through the bowels in stools (faeces). The skin and eyes turn yellow in jaundice because there is an increased amount of bilirubin in the body. Most babies who develop jaundice do not need treatment or extra monitoring. However, a few babies will develop very high levels of bilirubin, which can be harmful if not treated. In rare cases, it can cause brain damage.
Which babies are more likely to need treatment?
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
• babies whose mothers’ intend to breastfeed exclusively
• babies who have signs of jaundice in the first 24 hours after birth.
Your newborn baby should be checked for signs of jaundice at every opportunity, especially in the first 72 hours. This will include looking at the colour of your baby’s skin in natural light to see if they appear yellow. If your baby is at risk of developing high levels of jaundice soon after birth, the Doctor or Midwife should examine your baby to check for jaundice during the first 48 hours.
How can I tell if my baby has jaundice?
If your baby is jaundice, their skin may appear more yellow than normal. Often, Jaundice can be detected more easily by pressing lightly on the skin. If you gently press the tip of your baby’s nose for a few seconds and then release, you may see a yellow colour visible beneath the skin. A yellowing of the whites of the eyes and the gums are also helpful indicators of jaundice, particularly in babies with darker skin tones.
What should I do if I think my baby has jaundice?
You must contact Labour Ward immediately on 01908 996471 if:
• You think your baby is jaundiced, especially if the jaundice has developed in the first 24 hours of life.
• You are concerned that your baby is jaundiced and is unwell e.g. lethargic, not feeding well, ‘floppy’
• You are concerned that your baby has pale, chalky stools and/or dark urine
Testing for jaundice
If it looks like your baby has jaundice, it is important to measure the level of bilirubin as this will determine whether any treatment is required.
Babies in the first 24 hours
If your baby looks jaundiced in the first 24 hours after birth, your baby will need a blood test. If you are at home, you will need to be admitted to the postnatal ward for review by a Paediatrician. The blood test measures the level of bilirubin in the blood to see if the jaundice needs to be treated. Once the Doctor or Midwife knows the results of the blood test, more tests may need to be done to see if there is an underlying condition causing the jaundice.
Babies older than 24 hours
If your baby looks jaundiced and is older than 24 hours, the Doctor or Midwife will need to measure your baby’s bilirubin level. This can usually be done using a special handheld device placed briefly on the skin (a ‘bilirubinometer’). It won’t hurt your baby. If a bilirubinometer is not available, the reading is high or in certain clinical situations, the bilirubin levels will be measured using a blood test.
The Doctor or Midwife will use a table or chart to decide whether your baby’s bilirubin level will need treating and what kind of treatment would be best. If your baby needs treatment for jaundice, this will be done in hospital. The Doctor or Midwife should give you appropriate information about the treatment available for your baby.
The information should include:
• what the treatment involves
• how long the treatment is likely to last
• how you can hold, touch and feed your baby during their treatment
Phototherapy treatment for jaundice
If the Doctor or Midwife decides that treatment is needed because your baby’s bilirubin level is higher than expected, your baby will usually be treated using phototherapy. Phototherapy involves placing your baby, in just a nappy, under a special light that helps the body to break down the bilirubin and pass it out of the body in their stools. Your baby’s eyes will be protected, temperature monitored and your baby should be checked to make sure he or she stays hydrated (has enough fluid in their body). The treatment may be stopped from time to time for up to 30 minutes so you can hold, feed and cuddle your baby and change their nappy. You should be given help to ensure your baby is feeding effectively.
Checking to see if phototherapy is working
The level of bilirubin in your baby’s blood will need to be checked with a blood test every 6 – 8 hours after starting phototherapy to see if the treatment is working. Once the levels of bilirubin become stable or fall, they will still have to be checked every 6–12 hours. When your baby’s jaundice gets better, phototherapy can be stopped but your baby will need another blood test 6 hours later to make sure the jaundice has not returned to a level that would need further treatment.
Intensified phototherapy treatment
If your baby’s bilirubin level is very high, rising quickly or if your baby’s jaundice does not improve after phototherapy, your baby’s treatment should be stepped up. The healthcare team should offer ‘intensified’ phototherapy. This may either be carried out on Ward 9 or the Neonatal Unit depending on the level of treatment. This involves increasing the amount of light used in phototherapy. The phototherapy lamp may be turned up or another light source added to give more light. During intensified phototherapy, the treatment should not be stopped for breaks. If you are breastfeeding, you may need to temporarily express breastmilk. Your baby can continue to breastfeed normally again after phototherapy is stopped, and you will be offered extra help with this.
Depending on their exact circumstances, some treatments may not be suitable for your baby or additional treatments may be required. If you have questions about specific treatments/options, please talk to a member of your baby’s healthcare team.
Most jaundice resolves by 14 days of age. Jaundice that lasts longer is usually harmless but is sometimes caused by an underlying clinical condition. Babies who are jaundiced after 14 days of age are referred to the Prolonged Jaundice Clinic for further investigations.
NICE (2010) Jaundice in newborn babies under 28 days.