Updated: Nov 23, 2021
You may have heard that jaundice is incredibly common among newborn babies. As new parents the idea of not noticing illness in your child is terrifying. Is your child just pale or is there something more complicated going on?
Fret not, this article is here to help you navigate infant jaundice.
What is Jaundice?
Jaundice is caused by an abnormal level of bilirubin (bi li roo bin) in the blood vessels. Bilirubin is the product of the breakdown of red blood cells.
Normally, bilirubin is conjugated by an enzyme in the liver to become water-soluble. The conjugated bilirubin then travels through the bile ducts to the intestines which are then secreted out of the body through urine or faeces.
It is to be noted that although many other articles and newsletters may say otherwise, Jaundice is not a disease but rather is a symptom of an underlying condition.
Types of Jaundice
There are 3 different types of jaundice. Here is a breakdown for your easy reference.
Pre-hepatic jaundice happens when there is an excessive breakdown of red blood cells in the body which overwhelms the liver.
The liver is unable to conjugate all the bilirubin in the body which causes all the non-water-soluble bilirubin to stay in the bloodstream.
The most common kind of newborn jaundice is similar to this kind of jaundice because their livers are not fully developed yet and are unable to effectively conjugate all the broken down red blood cells causing an increase in bilirubin levels.
This jaundice is caused by the hepatic cells (liver cells) losing their ability to conjugate bilirubin.
This disorder may also lead to a blockage (spider angiomas) in the liver which causes both conjugated and unconjugated bilirubin to reside in the content of the blood.
Post-hepatic jaundice happens when there is an obstruction to the drainage of bilirubin. This can happen in various areas of the body such as the bile duct.
A blood test will show high levels of conjugated bilirubin remaining in the bloodstream because it cannot be effectively removed.
Symptoms of Jaundice in Newborns
Jaundice in a full-term baby normally appears within 3 days after the baby is born. This jaundice should be resolved by the second week of your baby's life.
However, in premature babies, it can take anywhere between 5 to 7 days for jaundice to appear and may even last longer for up to 3 weeks.
The method you choose to feed your child can also affect how long they may have jaundice, it is common for breastfed babies to have jaundice that lasts up to a few months.
Let's take a look at some of the symptoms of jaundice.
Yellowing of The Skin
Newborns with jaundice have a slight yellowing to their skin and eyes. This is caused by the increase in bilirubin a yellow substance in your child.
The yellowing normally starts at the skin on the face and head of the baby and might spread to your baby's chest and stomach. In some cases, the baby might even have yellowing on the arms and legs.
To check for yellowing you can look at the whites of the eyes or press down on your baby's skin with a finger and see if there is a yellow tint to the skin. In a normal baby, when you press down on the skin you will only see lighter skin colour.
Infant jaundice can be harder to spot if your baby's skin colour is darker. In this situation, focus on the whites of the eyes or seek advice from your doctor if you are unsure.
The health and safety of your child is the number one priority, don't be afraid to talk to doctors, experts and experienced people in your community for the advice!
Sleepier Than Usual Baby
One of the symptoms of Infant jaundice is that it can cause your baby to sleep more. This can be a sign of very high bilirubin levels in your newborn's blood.
Not Feeding Well
Your child might become fussy and not want to feed when they have newborn jaundice.
Inadequate feeding in a baby can also further perpetuate newborn jaundice by slowing down the movement of meconium, which has high bilirubin levels, that then ends up in the blood.
Dark Yellow Urine
Newborns have colourless or light yellow urine. A dark yellow stain on your baby's diaper may be a cause of concern.
The bile and bacteria from your baby's gut should make your newborn's poop yellow or orange. If your baby poops are pale it may be a sign of infant jaundice. This symptom isn't common in adults because we eat a lot of different food that contribute to the colour of our poops.
Risk factors of Newborn Jaundice
Six in every ten babies get jaundice. Many "normal" babies are just as likely to get this condition. However, there are a few situations that can raise the chances of your baby getting jaundice or increase the severity of jaundice.
A baby born before 37 weeks of gestation is likely to have a liver that is not as developed as a full-term baby. Their liver is not going to be able to conjugate bilirubin as fast as their peers saturating the level of bilirubin in the blood.
Bruising during birth
A infant that had a lot of bruising during birth might have higher bilirubin levels because of more breakdown of red blood cells.
Breastfed babies are more likely to develop jaundice. Breast milk can cause the liver to remove bilirubin less quickly.
This condition has been given the name breast milk jaundice and normally happens on the first week of breastfeeding.
Breast milk jaundice is not often dangerous to the baby and experts still encourage mothers to breastfeed because its benefits outweigh the risk. It is important to use all this information available when deciding how you want to feed your child.
Blood type incompatibility between a mother and baby can lead to an immune response where the fetus receives antibodies from the placenta. These antibodies cause a rapid breakdown of blood cells which overwhelms the liver and changes bilirubin levels.
Doctors have found that East Asian babies have a higher disposition for getting jaundice.
When Should You Seek Medical Advice for Infant Jaundice?
In most cases, infant jaundice is harmless and your baby does not need any medical care. Mild jaundice will subside within 2 to 3 weeks and your baby will be able to get rid of the excess bilirubin on their own.
In spite of that, if jaundice does not go away, it is important to consult a doctor to ensure that your baby's jaundice is not a sign of any underlying disease or disorder.
Contact your doctor or bring your baby to a hospital if your baby develops a fever higher than 38°C if the jaundice begins to spread and if the yellowing of your baby's skin worsens.
How is Infant Jaundice Treated?
Contrary to the old wives tale, putting your baby in the sun to expose them to direct or indirect sunlight is no longer a recommended way to treat jaundice. This is because the sunlight isn't reliable and may cause sunburn or a dangerous increase in your baby's body temperature.
Phototherapy is treated jaundice by exposing the baby to a special kind of light (remember not sunlight!!). The treatment works by reducing the bilirubin in the blood through photo-oxidation.
This process adds oxygen to bilirubin making it more water-soluble. The water-soluble bilirubin is then easily processed by the liver and excreted.
There are two kinds of phototherapy your doctor might use.
Your baby is laid under fluorescent or halogen lights with little clothing to expose as much skin as possible to the lights.
A blanket interwoven with fibreoptics is laid under your baby and which shines light onto your baby's back.
Exchange transfusion is a type of blood transfusion done in emergency cases when phototherapy does not reduce the extremely high bilirubin levels in the blood.
Your baby's blood will be transfused out of the body though a thin plastic tube and replaced with blood from someone with a compatible blood type.
Sometimes a high saturation of bilirubin in a baby's blood is caused by dehydration. In this condition your child will be given fluids to help them stay hydrated and decrease bilirubin levels.
If the jaundice is caused by other health problems, those conditions need to be treated. These treatments can vary from simple medication to surgery. Stay calm and listen to your doctor, your baby will be alright.
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We hope that this article has given you the information you need to help you navigate newborn jaundice. All the best in combating this yellow skin causing condition. You are doing great super-parent!