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Jaundice is caused by the liver not being fully developed and not yet fully functioning properly.
The skin of a baby with jaundice will look slightly yellow. In some babies the yellowing can be noticed in the whites of the eyes.
Jaundice is more common in boys than girls and in premature babies.
Symptoms of jaundice in newborn babies
Jaundice usually appears 2-3 days after birth. In premature babies, who are more prone to jaundice, it can take 5-7 days to appear and usually lasts slightly longer. Jaundice is also more common in babies who are breastfed.
A jaundiced baby's skin will look slightly yellow, it often looks like a suntan. In babies with dark skin, the yellowing can be noticed in the whites of the eyes and the soles of the feet and palms of the hands.
Jaundice usually starts on the head and face and spreads to the chest and stomach. In some babies it reaches the legs and arms.
Your baby may have other symptoms, including itchy skin, poor sucking/feeding, sleepiness, dark urine or pale stools. See your GP as soon as possible if you think your baby is ill.
Causes of jaundice in newborn babies
The liver is a very important organ. One of its functions is to remove a yellow chemical, called bilirubin. Bilirubin is found in bile and made from the breakdown of red blood cells, which carry oxygen around the body.
The body usually removes bilirubin from the bloodstream and it passes though the liver and to the kidneys for disposal.
Newborn babies have a greater number of red blood cells than normal at birth and these are broken down more quickly. This makes more bilirubin, which the liver needs to get rid of. In newborn babies the liver is not fully developed and cannot work efficiently yet, so bilirubin builds up and causes jaundice.
In some cases the mother's milk may contain a harmless substance that makes the baby jaundiced. There is no need to stop breastfeeding (see complications).
Other, rarer, causes of jaundice include:
- liver disease,
- an underactive thyroid gland,
- rhesus incompatibility (when the mother and baby have different blood types),
- inherited deficiencies in enzymes,
- blockages of the bowel or bile duct, and
Diagnosing jaundice in newborn babies
When your baby is born, the doctors will check for jaundice, but it doesn't usually appear for a few days. If it is noticed, your baby may be kept in hospital for a few days for observation.
When your baby comes home from hospital, keep an eye on them. Check their skin and whites of the eyes in a well-lit room. Your midwife or health visitor will also check for jaundice.
To test for jaundice, gently press your fingers on the tip of your child's nose or forehead. If the pressed skin goes white, your child does not have jaundice; if it goes yellow, you should see your GP as soon as possible.
If the doctor thinks your baby may have jaundice they may do a blood test (serum bilirubin or SBR). This is to check for levels of bilirubin in the blood. If your baby's symptoms of jaundice last for longer than two weeks, another blood test may be carried out. This is called a split bilirubin test and determines whether your baby's jaundice is caused by an underlying liver disease.
Other indications of jaundice are the colour of your baby's urine and stools. The urine of a newborn baby should be colourless. The stools of a newborn baby should not be pale. If they are breastfed the stools should be greeny-yellow, and if they are bottlefed the stools should be a greeny-mustard colour.
Treating jaundice in newborn babies
As long as your baby is well, there is no need for treatment as jaundice usually disappears after a few weeks. See your GP immediately if the jaundice does not disappear after this time. Also see your GP if his/her stools are pale or urine is dark, or if the jaundice spreads to the arms and legs.
In some cases, a jaundiced baby has to have a treatment called phototherapy. The baby is placed under a UV (ultraviolet) lamp, called a bili-light for about 1-2 days. The baby is usually naked and has its eyes covered up. This light treatment helps the body get rid of the bilirubin and makes it easier for your baby's liver to get rid of it. The side effects from phototherapy may include a rash and diarrhoea.
If the jaundice is severe and bilirubin levels are very high, a blood transfusion may be needed. This is called exchange transfusion. This procedure will only be considered if phototherapy has not worked.
If jaundice is caused by something else, such as an infection, this will have to be treated as appropriate. This may mean surgery or drug treatment.
Complications of newborn jaundice
Without prompt treatment, a build up of bilirubin in the brain can lead to a condition called kernicterus. This can lead to brain damage or even death, so it is important that high levels of bilirubin are treated immediately.
If the levels of bilirubin rise dramatically about six or seven days after birth, it may be caused by breast-milk jaundice. This occurs in two out of 100 breastfed babies, but usually clears up in about two weeks. The mother may be asked to stop breastfeeding for a few days to see if the levels drop.