If you observe a tinge of yellow in your newborn’s skin and eyes a few hours or days after birth, you may be alarmed and assume your baby has an infection. However, there’s no need to go into panic mode! 

This mild medical condition is known as jaundice. It affects about 50 percent of full-term babies in the first week of life and an estimated 80 percent of premature babies. It’s one of the most common conditions among newborns, and usually doesn't hurt your baby. 

Newborn jaundice

Newborn jaundice is a common condition that particularly affects those born before 38 weeks' gestation (pre-term babies) and some breast-fed babies. It typically begins on the second or third day after birth. 

Jaundice happens when there is too much bilirubin in the baby’s blood. Bilirubin is a yellowish substance found in bile (a fluid that is found in the liver). It is produced when red blood cells break down, and is naturally excreted. However, when the liver is unable to process it, bilirubin can leak into the blood

When you are pregnant, your body helps to remove bilirubin from your baby’s blood through the placenta. Once your baby is born, his body must get rid of the bilirubin on its own. Newborns typically make more bilirubin than adults as well, due to their higher turnover of red blood cells. 

By the time a baby is around 1 to 2 weeks old, their liver will be more effective at processing bilirubin. As such, jaundice often corrects itself by then without causing harm.

Types of newborn jaundice

Physiological jaundice: The most common type of jaundice in babies that is usually most evident when the baby is two to four days old. It usually isn’t serious and goes away within two weeks. This is seen as after your baby’s liver develops, it will start to get rid of excess bilirubin. 

Breastmilk jaundice: A type of jaundice seen in healthy breastfed babies, usually after the baby is a week old. It likely peaks during week two or three, and may take a month or more to disappear. Substances in your breast milk can affect how your baby’s liver breaks down bilirubin. This can cause a bilirubin buildup.

Breastfeeding jaundice: This happens when a baby does not get enough milk, possibly due to a poor latch during breastfeeding or if the mother’s milk is slow to come in. Adequate amounts of breastmilk increase a baby’s bowel movements, which help eliminate the buildup of bilirubin. Breastfeeding jaundice will often resolve itself with increased feedings, and help from a lactation consultant to make sure the baby is taking in adequate amounts of breastmilk. 

Blood group incompatibility-related jaundice: If a baby and his mother have different blood types, the mother may produce antibodies that destroy the newborn’s red blood cells. This usually occurs during the first 24 hours of the baby’s life, and is caused by a sudden buildup of bilirubin in the baby’s blood. 

Severe jaundice can occur if your baby has:

- A blood infection (sepsis)
- Bruising from a difficult birth
- Too many red blood cells
- A low oxygen level (hypoxia)
- A liver condition 
- A specific enzyme deficiency or a metabolic disease
- Premature birth or low birth weight
- G6PD deficiency (common in Singapore)
- ABO and Rhesus incompatibility

Signs and symptoms of jaundice

Early signs of newborn jaundice include:

- A yellowish tinge in the skin and whites of the eyes. It is usually detected first in the whites of the eyes or face, then progresses to the chest and stomach and to the legs.
- Skin that looks yellow when light pressure is applied.

Symptoms of severe jaundice, which may indicate an underlying medical condition, include:

- Jaundice that spreads or becomes more intense
- Deepening of the yellow colouring
- Fever of over 38 degrees Celsius
- Poor appetite
- Listlessness or lethargy
- High-pitched crying

Diagnosis

If your newborn appears jaundiced in the hospital, the nurse or doctor may do a jaundice screen with a device applied to the skin (transcutaneous bilirubinometer), and confirm the bilirubin level by a blood test from a heel prick.

Based on your newborn's age and level of bilirubin, the doctor will advise you on what to do. Here is a general guide to abnormal levels of bilirubin based on a baby’s age:

Source: https://americanpregnancy.org/healthy-pregnancy/first-year-of-life/newborn-jaundice/ 

Treatment of jaundice

Most cases of newborn jaundice do not require treatment, as the baby’s body becomes able to get rid of the excess bilirubin on its own. 

Feeding

A mother may also be advised to increase their breastmilk feedings or supplement with formula to help the baby pass the bilirubin out in their stools. Do also ensure that your baby is latching well and drinking adequate amounts of milk. It’s best to work with a lactation professional in this area.

Phototherapy

For higher levels of jaundice, phototherapy may be recommended. This involves safely placing a baby naked under a bright ultraviolet light source (with a protective mask over the eyes). The number of lights is proportional to the levels of bilirubin. The light breaks down the bilirubin in the skin, and makes the jaundice fade. Do also be aware that unsupervised exposure to direct sunlight is not recommended, as it can be harmful and cause sunburn.

Blood transfusion

If your baby's jaundice is caused by a health issue, like an incompatible blood type with the mother, your doctor may recommend a blood transfusion or other treatment options. With a blood transfusion, the baby's blood is replaced with fresh blood to wash the bilirubin out of the system. A blood product (immunoglobulin) may also be infused to prevent the baby’s red cells from being coated by maternal proteins (antigens) and destroyed by a different group of cells in the baby’s blood (macrophages), a process known as haemolysis.

When should I be concerned and consult a doctor? 

In rare cases where a baby's high bilirubin level isn’t treated, this could cause brain damage (kernicterus), leading to serious lifelong problems for the child.

Bring your little one to the doctor immediately if he is getting more yellow, becoming sluggish and excessively sleepy, cranky or jittery, not feeding well, develops a high pitched cry, or starts to arch his back in an unusual way. These signs point to a more serious case of jaundice that warrants immediate attention.

Can jaundice be prevented?

Jaundice is a common condition in newborns and is difficult to prevent. If you have gestational diabetes, make sure this condition is under control during your pregnancy to reduce the likelihood of your newborn getting jaundice.

Also, make sure you follow up with your ob-gyn to look out for possible low birthweight, or risks of pre-term labour. After delivery, make sure your baby gets enough milk. If you aren’t sure whether your baby is getting enough milk, ask your doctor or lactation consultant for help.

It is also important to ensure good fluid intake for all newborn babies, as jaundice is often exaggerated with mild dehydration. Jaundice levels can also be prevented from escalating with timely phototherapy and treatment of any risk factors like infections and blood group incompatibility. 

If you suspect your baby has jaundice, make an appointment with a paediatrician. 

Thomson Paediatric Centre has dedicated and experienced paediatricians who treat a wide array of infant and child medical conditions, including acute and chronic illnesses. Make an appointment here.

Photo: iStock

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