Jaundice is a medical term used to describe the yellowing of a baby’s skin. Jaundice is extremely common – in fact, the vast majority of babies develop a degree of jaundice, most of whom do not require treatment.

What causes jaundice?

Jaundice is caused by a yellow pigment in the blood called bilirubin. Bilirubin is a normal by-product of red blood cell breakdown. Newborn babies are born with extra red blood cells, and when these break down, bilirubin enters the blood. The bilirubin can then be passed out in the poo. If the body cannot keep up with getting rid of the bilirubin, this can build up and cause jaundice.

Jaundice can occur without any underlying cause. Breastfed babies are more likely to develop jaundice, but this should not in any way put you off from breastfeeding – breastfeeding is still our recommended option for all of its wonderful benefits. Sometimes there is an underlying cause, such as an infection or an incompatibility between the mother and baby’s blood types. Very occasionally there is a blockage of the bile duct, which may require an operation.

If you have a family history of jaundice, it is worth letting your midwife or medical team know.

How is jaundice identified?

Jaundice is specifically looked for in the newborn check, but it is worth keeping an eye out for it over the first few days. With jaundice, babies’ skin starts to become yellow – it is often best to have a good look in natural light. As well as having yellow skin, the whites of their eyes may also become tinged with yellow.

In some causes of jaundice, babies may have pale stools and dark urine.

If you notice your baby has jaundice, you should speak to a health professional, be it a midwife, health visitor, GP or other doctor, to determine whether your baby requires treatment.

When does jaundice appear and disappear?

Most often, jaundice appears within the first few days of life and normally disappears within the first two weeks of life, although in premature babies it is common to last a bit longer. Rarely, it can appear within hours, and these babies may require extra monitoring and tests.

If you notice your baby has developed jaundice, you should discuss with your midwife (if an inpatient) or your GP/health visitor (if an outpatient).

What happens next?

Once your baby has been identified as having jaundice, they will need a test to assess the level of their bilirubin.

There are two main ways of testing the jaundice level in babies.

1. The light test: This test uses a machine called a bilirubinometer, which shines a light on to the skin of your baby. This is good because it is non-invasive. However, it is not accurate above certain readings.
2. Heel prick test: This is a quick and simple way of taking a sample of blood from your baby. This is accurate even at high bilirubin levels.

Sometimes, further blood tests will be required. It can be useful to test for the blood group, red blood cells or infection markers if an underlying cause is suspected.

Jaundice will require treatment above certain bilirubin levels. There are jaundice graphs which tell doctors the levels that require treatment, as this depends on the gestational age and the number of days old your baby is. If your baby’s jaundice does not require treatment, it is important to continue feeding regularly. They may need to be woken for feeds, or even topped up if necessary.

The most common treatment for jaundice is phototherapy, where a blue UV light is used to help the bilirubin dissolve. Most often, babies can have brief pauses from being under the lights to be breast/bottle feed. However, they may require intravenous fluids through a drip if they are dehydrated or if the level is high. Rarely, other treatments such as a blood transfusion might be required.

During treatment, regular blood samples will be checked to monitor their bilirubin levels.

How can jaundice affect my baby?

At low levels, jaundice will not affect your baby at all. At higher levels, babies may become sleepy and might have feeding difficulty, with poor suck.

Health professionals are very interested in making sure bilirubin does not reach levels that are too high, as it can cause damage to the developing brain, called ‘kernicterus’. These days, this is almost unheard of because of the way we identify and treat jaundice.

Conclusion

Jaundice is an extremely common condition in newborn babies due to the ways their bodies are adjusting to their life outside the womb. If treatment is required, this is most often in the form of UV light, but there are other treatments that may be required through a drip. It is important to treat jaundice to prevent brain damage at high levels, which is very rare.

Main points

• Jaundice describes the yellowing of a baby’s skin.
• Jaundice is caused by a yellow pigment in the blood called bilirubin, which is a normal by-product of red blood cell breakdown.
• Jaundice occurs when the body cannot get rid of bilirubin sufficiently, causing it to build up.
• Breastfed babies are more likely to develop jaundice, but mothers should not be put off breastfeeding, as its benefits outweigh any potential risks.
• Underlying causes of jaundice include an infection, incompatibility between the blood types of the mother and baby, and a blockage of the bile duct.
• As it’s extremely common, jaundice is looked for in the newborn check, but parents should also look out for symptoms over the first few days of life.
• Other than the yellowing of the skin, symptoms include pale stools and dark urine. Yellowing may also occur in the whites of their eyes. You should seek health from a health professional if you notice any of the symptoms.
• Most often. jaundice appears within the first few days of life and normally disappears within the first two weeks of life, although in premature babies it is common to last a bit longer.
• If your baby is identified as having jaundice, they will have a test to assess their bilirubin levels. They will either have a light test using a bilirubinometer or a heel prick test, where a sample of blood is taken.
• If the tests show that your baby has high bilirubin levels, they will require treatment. The most common treatment for jaundice is phototherapy, which uses UV light to help bilirubin dissolve.
• Jaundice may cause your baby to become sleepy and have feeding difficulty. A more serious complication is kernicterus, but this is extremely rare.