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
Babies with significant bruising
Babies born to mothers with blood group incompatibility or other risk factors of haemolysis

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 Maternity Triage on 01908 996 483 (24/7).
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. The amount of jaundice does not corelate with bilirubin levels, which is why a formal test is needed to measure bilirubin levels.

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.

Treating jaundice

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. This will involve placing your baby on a mat that has a light, and/or in a cot under a special light. Your baby will need to be undressed and in just a nappy whilst having the light therapy, to allow the body to break down the bilirubin and pass it out of the body in their stools. Your baby’s eyes will be protected with a small mask, their temperature, Heart rate and breathing will be monitored every 4 hours and your baby should be checked to make sure he or she stays hydrated (has enough fluid in their body).

Whilst on the light mat, you can lift your baby out of the cot and still feed them whilst they continue to receive treatment.(updated as we now use bilisofts not just overhead lights) 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 4-6 hours after starting phototherapy to see if the treatment is working. Then the bloods will be checked every 6–12 hours as the levels begin to stabilise or fall. When your baby’s jaundice gets better, phototherapy can be stopped but your baby will need another blood test 12-14 hours later to make sure the jaundice has not returned to a level that would need further treatment. (Changed in line with our guideline)

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 9/10 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.

Prolonged jaundice

Most jaundice resolves by 14 days of age. Jaundice that lasts longer is usually harmless but is occasionally 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.

References

NICE (2010) Jaundice in newborn babies under 28 days.