Jaundice is a yellowing of the skin, and sometimes the whites of the eyes or the gums. If your baby has dark skin, the main sign may be a yellowing in the whites of their eyes or the gums. Mild jaundice is quite common in newborn babies and is usually a temporary condition that causes no problems. However, severe cases of jaundice can be harmful, so if you think your baby has jaundice, it is always best to let your doctor or nurse know.
What causes jaundice?
Jaundice is caused by bilirubin (a yellow substance) accumulating in the blood. Bilirubin is a normal waste product produced when used red blood cells are broken down. It is normally passed out of the body in urine and faeces (poo). Newborn babies produce and break down a large amount of red blood cells very quickly and in the first few days it can be hard for their bodies to get rid of the bilirubin. Usually, as soon as the liver matures and functions more effectively, the jaundice will go away. In rare cases there can be other underlying problems such as blood type incompatibility or infection. If the jaundice persists past a few weeks your doctor may consider other causes such as thyroid or liver problems.
Signs and symptoms
The yellow colour of the skin is the main symptom of jaundice, usually beginning on the baby’s face and moving down to the chest, abdomen, legs and finally to the palms of the hands and soles of the feet. The whites of the eyes or the inside of the mouth or gums may also look yellow. Babies with jaundice may also be sleepy and not feed well.
How is it diagnosed?
- Your child’s doctor will look for signs of jaundice, and ask questions about birth weight, weight gain and feeding.
- A screening test with a specialised light called a transcutaneous bilirubinometer is sometimes used on your baby’s chest to get an approximate measure of the jaundice.
- A blood test to measure the level of bilirubin in your baby’s blood, called serum bilirubin level (SBR), may be ordered. This is the most accurate way to measure an SBR and involves collecting a small amount of blood from the arm, hand or heel. Additional blood tests or urine tests may be ordered if there is evidence your baby’s jaundice is caused by an underlying disorder that will need treatment.
Treatment
Mild jaundice often goes away without treatment, however babies with high levels of bilirubin may need treatment. Treatment may include phototherapy, exchange transfusion or medication.
Phototherapy
Phototherapy is safe and effective in reducing SBR levels. As bilirubin absorbs light, jaundice and increased bilirubin levels usually decrease when the baby is exposed to these special blue coloured lights. The lights help the bilirubin in the blood to change so it can easily be removed from the body in the urine and faeces. Phototherapy may take several hours to begin working and is used throughout the day and night.
Your baby will receive phototherapy from overhead lights or through a specially designed fibre-optic blanket
Overhead lights
Your baby will be placed in a special cot called an isolette to keep him/her warm while a certain type of light is shone onto them. This light helps to break down the bilirubin, which will then be passed out of your baby’s body in their urine and stools.
Your baby will be placed under the light naked, apart from their nappy, to make sure that the light shines on as much of their skin as possible.
Eye pads will be placed over your baby’s eyes to protect them.
Fibre-optic blanket
A fibre-optic pad with a special type of light that breaks down the bilirubin is placed directly against your baby’s back to make sure that the light shines on as much of their skin as possible. Your baby may still wear clothing and wraps over the outside of the pad as normal. Your baby can feed while the treatment is taking place.
What will happen while my baby is having phototherapy?
A blood test to measure the amount of bilirubin in your baby’s blood will be taken at least once a day.
- You will be encouraged to take your baby out from under the light for short breaks for feeds, nappy changes and cuddles. You can usually continue to breastfeed your baby during phototherapy. If your baby’s bilirubin level is very high, more than one lamp will be used at the same time and your baby will need to stay under the lamps without breaks.
- The nurses will monitor your baby’s feeding closely to make sure they are feeding enough.
- The nurses will monitor the urine output and bowel motions from your baby, by weighing nappies
- Your baby will lie on their back under the phototherapy lights, this is recommended for safe
- Your baby will be weighed each day to allow the nurses to monitor fluid status
- Your baby’s temperature will be checked regularly to prevent him/her from becoming too cold or hot.
- Your baby may require periodic blood tests to check the serum bilirubin level (SBR).
Side effects of phototherapy
Minor side effects may include loose, green bowel motions, dehydration and skin rash.
Phototherapy may increase fluid loss. If you are breast feeding you will be encouraged to continue to breastfeed your baby at least 8 to 12 times a day. This will help increase your milk supply and decrease your baby’s bilirubin levels. Increased feedings will increase bowel movements, which will help remove the bilirubin.
If your baby is unable to feed enough the nursing staff can give extra fluids either by bottle, through a tube via the nose into the stomach or through a cannula (IV drip) to make sure your baby is hydrated.
If you have questions about your baby’s treatment or condition, please ask the nurse or the medical team caring for your baby.
Does jaundice cause any long-term problems?
For most babies, jaundice does not cause any long-term problems. In very severe cases, the amount of bilirubin in a baby’s blood is so high that it can damage parts of the brain including parts that affect hearing, vision and control of movement (this is called kernicterus). With the right treatment this small risk is reduced even further.
Going home
When your baby’s SBR reaches a safe level, phototherapy will be stopped. At this time your baby may still appear jaundiced. This is not unusual, and it may take two to three weeks for skin discolouration to disappear. Before you go home with your baby, the doctors and nurses will make sure your baby is alert and feeding well.
When to seek help
See your GP if your child has any common symptoms or if your baby:
- has jaundice for more than 2 weeks in a term baby and 3 weeks in a preterm baby
- has skin that becomes more yellow
- has pale, chalky coloured poo
- isn't feeding well
- is not gaining weight, listless or difficult to wake
In an emergency, call Triple Zero (000) and ask for an ambulance.
If you're not sure whether to go to an emergency department, call 13 HEALTH (13 43 25 84) and speak to a registered nurse.
Developed by the Division of Medicine, Queensland Children’s Hospital. We acknowledge the input of consumers and carers.
Resource ID: FS125. Reviewed: May 2022.
Disclaimer: This information has been produced by healthcare professionals as a guideline only and is intended to support, not replace, discussion with your child’s doctor or healthcare professionals. Information is updated regularly, so please check you are referring to the most recent version. Seek medical advice, as appropriate, for concerns regarding your child’s health.