Jaundice in newborns

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What is jaundice?

Jaundice is a condition that causes the skin to appear yellow. It occurs when bilirubin builds up in the blood.

Bilirubin is released when the liver breaks down red blood cells. Normally, the bilirubin passes out of the body as bile through the intestines. If the liver cannot break down the bilirubin quickly enough, the bilirubin from the blood seeps into the skin, making a baby look yellow.

Jaundice can be common in newborns and usually appears in the first week of life.

Signs and symptoms of jaundice

The most common sign of jaundice is yellowish skin and eyes. Other symptoms include:

• drowsiness
• difficulty feeding
• reduced poops and wet diapers

Causes of jaundice in newborns

The most common cause of jaundice in newborns is physiological, or benign. This can happen because newborn babies:

• produce more bilirubin than older children and adults since their red blood cells break down more quickly
• may have a build-up of bilirubin in the blood because their young livers cannot yet remove it quickly enough

Jaundice is more common and can be more severe in babies with:

• a history of prematurity
• difficulty feeding or inadequate intake of milk
• an older sibling who had severe jaundice
• mothers who had diabetes mellitus during pregnancy
• a mismatch between the blood types of mother and baby
• bruising or scalp swelling from birth
  
• an inherited condition such as G6PD deficiency
• congenital hypothyroidism
• an infection in the blood or urinary tract
• problems of the liver, intestine or gut (rare)

How jaundice is diagnosed

All babies in Canada have a blood test to check their bilirubin level around 24 hours after they are born, before leaving the hospital. At that time, you may be told that your baby needs treatment for jaundice or needs repeat blood testing to monitor for jaundice. Some hospitals also screen newborns using a machine on the skin called a transcutaneous bilirubinometer.

If your baby develops jaundice after leaving hospital, their health-care provider will examine them and may screen them with a transcutaneous bilirubinometer. A blood test is used to confirm the diagnosis.

• If the level of bilirubin is high, the health-care provider will admit your baby to the hospital for treatment.
• If the test shows that the level is moderately high but not high enough to need treatment, a follow-up visit will be arranged for a repeat blood test.

How jaundice is treated

Phototherapy

Phototherapy means “treatment with light”. The light changes the bilirubin to a form that can be passed out of the body more easily.

1. Your baby will be placed naked in an isolette (baby incubator), and an eye patch will be placed over their eyes to protect them from the phototherapy lights. The isolette will keep your baby warm while they are undressed.
2. A light will be placed over and sometimes beside the isolette.
3. Your baby’s skin and blood will absorb the light waves and convert the bilirubin to a form that can be passed out of the body more easily.

Some hospitals also use a “biliblanket”—a blanket placed under the baby’s back—as a way to treat a baby’s jaundice with light.

Phototherapy is completely safe, but it does mean less time for skin-to-skin contact with your newborn. The health-care team may also ask you to limit your feeds to 30 minutes to give your baby as much time under the light as possible.

A repeat blood test is collected after a newborn has been treated with phototherapy to ensure that the bilirubin level is dropping with treatment.

Feeding

An increase in your baby’s milk intake will also help to treat the jaundice. The health-care team may recommend that you give your baby expressed breast milk or formula in addition to normal breastfeeding. If the jaundice is severe, your baby may need an intravenous (IV) line to give fluids into their vein.

How to prevent jaundice

Feed your baby at least every three hours for the first couple of weeks of life. You may feed your baby more often, for example every two hours, if they seem hungry. Do not let your baby go for more than three hours without a feed until their health-care provider says you can (usually once your baby has regained their birth weight at around two weeks).

Complications of jaundice

Most babies with jaundice do not have any long-term complications. A very small number of babies with severe jaundice from high levels of bilirubin can develop a condition called kernicterus, but this is rare. Kernicterus can lead to lasting brain damage, hearing loss and problems with motor development. Health-care staff are very careful about monitoring and treating babies for jaundice to prevent kernicterus.

When to see a health-care provider about jaundice

See your baby’s health-care provider if your baby:

• appears more jaundiced (yellow)
• is not feeding well
• is showing signs of dehydration​​​

Go to the nearest emergency department if:

• your baby is lethargic, inactive or difficult to wake up for feeds
• your baby is vomiting (throwing up)
• your baby has a fever
• the jaundice is getting worse and your baby's health-care provider is not available

Your child may show physical changes when their condition is serious or when their condition gets worse. Parents and caregivers can learn how to spot these signs in order to seek help from a health-care provider.