Jaundice

Jaundice is a common condition which affects many newborn babies. It is usually mild and causes a yellow tone to the skin and sometimes to the sclera (whites of the eyes). It usually resolves after a few days and isn’t too much of a concern. However, occasionally babies will need treatment for jaundice. This is most likely to be in the form of phototherapy, but if it is severe then an exchange transfusion may be advised, this is rarer.

Jaundice occurs because when babies are in the womb, they have many more red blood cells than average to allow for extra oxygenation. Once baby is born, these extra cells need to be broken down, a by-product of this is a yellow substance called bilirubin. The baby’s liver will then change the form of the bilirubin into something that can be passed out in their poo. A baby will appear jaundice when there is a build up of bilirubin in the fat layer just under the skin and this can indicate that the liver is struggling to process the bilirubin. 

There are two types of jaundice:

• Physiological jaundice – when the baby shows signs of jaundice after the first 24 to 48 hours of life. This is the most common type of jaundice. 60% of babies will show some signs of jaundice, of these babies, 1 in 20 will require treatment. Factors that can increase the chance of your baby having jaundice are; prematurity, an instrumental birth, low birthweight, maternal diabetes, male baby, a sibling who had jaundice and required treatment, dehydration, Asian, European or native American ethnicity.
  
  
• Pathological jaundice – when the baby shows signs of jaundice within the first 24 hours of life. Causes of this can include; blood group incompatibility, sepsis, bruising, metabolic disorders, Gilberts Syndrome, Crigler-Najjar Syndrome, Glucose6-phosphate-dyhydrogenase deficiency, congenitial obstruction and malformations of the bilary system.

Whilst on maternity ward your midwife will offer to carry out a daily check on your baby and part of this will involve observing for signs of jaundice. Your midwife will also ask you questions about how often and for how long baby is feeding, the colour and quantity of baby’s bowel movements and sleeping pattern.

If the midwife is concerned about the tone of baby’s skin along with other factors (listed below), they will ask to carry out a non-intrusive test called a transcutaneous bilirubin test, this involves hovering a device over baby’s forehead and gives an immediate indication of the level of bilirubin in the blood.

If this reading is high a blood test will then be advised, which involves pricking baby’s heel and collecting a small sample of blood. If this result is also high it will be advised that your baby receives phototherapy. 

Signs and symptoms of jaundice:

• Yellowing of the skin and sclera (whites of the eyes)
• Sleepy, difficult to rouse
• Poor feeding
• Pale stools and/or dark urine (baby’s urine should be clear)

If your baby is jaundiced and is sleepy, difficult to rouse and not interested in feeding, please ring Triage immediately.