My baby looks yellow! Jaundice explained
Newborn jaundice is common and usually harmless! It appears at about 3 days after birth and disappears by 2 weeks of age. In premature babies, it can take 7 days to appears and last for 3 weeks. It also tends to last longer, up to several months, in babies who are breastfed. The skin looks yellowish, starting on the head and face, spreading to the chest and stomach and sometimes to the arms and legs. For babies with darker skin, yellowing may be more obvious in the whites of the eyes, inside the mouth, on the soles of the feet and palms of the hands.
Newborn babies are prone to jaundice because they are born with many red blood cells that are needed while the baby is in the womb, but not once the baby breathes air. So after birth, the excess red blood cells are destroyed (haemolysis) and a by-product is bilirubin. Bilurbin is transformed by the liver, eliminated in the stools and some goes into the urine. What's more, newborn babies are also born with an immature liver that does not transform bilirubin easily. So while a newborn baby's excess red blood cells are haemolysing and until the liver begins to function (2-3 weeks following birth), excess bilirubin can build up in the blood and causes this yellowish discolouration. Breastfeeding can also increase the chances of jaundice. It is thought that breast milk contains substances that reduce the ability of the liver to process bilirubin. Another factor is that on initiation of breastfeeding, some babies do not get enough milk, become a bit dehydrated, which will increase the concentration of bilirubin in the blood.
Though neonatal jaundice is very common, it is important to monitor it. Sometimes bilirubin blood levels rise very high and this can be dangerous to the central nervous system.
There are rare conditions that can cause jaundice other than Neonatal Jaundice, these are linked to red blood cell disorders, incompatibilities of blood groups between mother and baby, liver diseases or ongoing infections. Thankfully the issues due to blood group incompatibility are rare in Europe as those professionals looking after you during pregnancy, now know to look out for them and what to do to avoid. with these conditions, jaundice usually becomes apparent within 72 hours, though can be later and/or lasts for more than 3 weeks. Jaundice in some of these conditions can be associated with blackish urine and pale whitish poos. The healthcare professional looking after your baby will need to initiate further investigations, blood tests etc, so it is important to show your baby to them, if you are concerned in any way.
How is jaundice monitored?
The monitoring is first done by looking at babies, assessing the yellowness of the skin, eyes, hands and feet and the way they feed. If there is doubt, or if a baby is clearly very yellow or does not not feed well, it becomes necessary to perform an objective measurement of the blood level of bilirubin. This is done using a bilirubinometer which shines light on the skin and calculates the level of bilirubin by analysing how the light reflects off or is absorbed. A blood test taken by pricking a baby's heel is done only if the reading is high or if baby develops jaundice within 24 hours of birth. The level of bilirubin detected in the blood is used to decide whether any treatment is needed.
How is jaundice treated?
If jaundice requires treatment, the baby is placed under special florescent lights 'bililights' or 'bili blanket', this is known as phototherapy. The lights break down bilirubin in the skin and removes it from the body. The baby's eyes are covered to protect them from the light. Since excess bilirubin is excreted in baby's poo, it is important to keep baby well fed encouraging the passing of faeces. Babies with more serious forms of jaundice or with very high bilirubin levels may need more intensive therapies. The most common is an exchange transfusion during which a baby's blood is gradually withdrawn in small amounts and replaced with donated blood. This removes the dangerously high bilirubin from the baby's body. It is rarely required these days!
Should I stop breastfeeding?
For breastfeeding related jaundice, there is no need to stop breastfeeding. Often by giving extra fluids and more frequent feeds, the jaundice lessens. For those breastfed babies who remain jaundiced for more than 3 weeks, the blood tests will confirm that prolonged 'breast milk jaundice' is indeed the diagnosis.