Neonatal Jaundice

Jaundice is very common in newborn babies in the first week of life. In fact if you measure the jaundice level (bilirubin) in all babies it will rise until day 7-8, then drop to normal levels in the second week. The cause of this physiological jaundice is the breakdown of extra red blood cells which babies need in the womb but don’t need after birth. In some babies the jaundice is so mild you don’t notice it. In others the jaundice is obvious, starting on day 3, getting worse until day 7, then getting slowly better. So the redder the baby at birth, the greater the chance of jaundice.

What causes jaundice in the newborn?

  • Physiological jaundice is the most common cause (discussed above)
  • Blood group mismatch, either Rhesus or ABO, between mother and baby can result in breakdown of the baby’s red blood cells (haemolysis) which causes jaundice, usually in the first 2 days of life.
  • Prematurity – a premature baby is more likely to develop jaundice than a term baby because of an immature liver.
  • Breastfeeding jaundice happens when the baby loses a lot of weight because of feeding problems and becomes dehydrated which makes physiological jaundice worse. The solution is breastfeeding support.
  • Breastmilk jaundice –  about 2% of breastfed babies have mild jaundice from certain hormones and enzymes in breastmilk, which can last for up to 10 weeks and is absolutely harmless to the baby, who is otherwise completely well and gaining weight.

There are many other rare causes of jaundice (thyroid problems, infection or inflammation of the liver, inherited/genetic problems with red blood cells or enzymes) which mostly make the baby ill with poor feeding, weight loss, drowsiness and fever or vomiting.

Is jaundice dangerous?

If the bilirubin level gets very high it can damage the baby’s brain, so to prevent this we do a test if the baby looks very yellow to see what the level is, and treat the baby with phototherapy (lights) in hospital if the level is above a certain number. We then check the level every day until it is low enough to stop the lights. Remember that the level for starting lights is far below the level that is dangerous.

What can I do to prevent jaundice?

Getting the breastfeeding going as soon as possible will stop the baby from becoming dehydrated, which will prevent jaundice from being worse than usual. So a baby who is gaining weight after day 3 is partially protected from severe jaundice.

What should I do if my baby has jaundice?

  • Well baby – if the baby is yellow enough to bother you but otherwise well, have the jaundice test done (bilirubin) and phone your doctor to discuss the result. If the level is high enough, the baby will need phototherapy in hospital. If the baby doesn’t need lights, a few minutes of sunlight in the early morning or late afternoon will help.
  • Ill baby – if the baby is feeding poorly, losing weight, drowsy, feverish or vomiting he/she should be seen urgently by your doctor.

 

 

 

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