Newborn Jaundice

June 27, 2014
Caring for a newborn causes moments of anxiety as well as joy for most new parents. After the rush of giving birth, comes the worry about whether baby is progressing normally in the first few days of life.
Although it affects almost 50 per cent of all babies in the first seven days, newborn jaundice is a significant health concern for only about five per cent of newborn babies, according to Dr. Keyvan Hadad, Medical Director of the Intermediate Nursery at BC Women's Newborn ICU.

If your baby is jaundiced, you may see a yellowish colour in the whites of the eyes or skin. Jaundice is caused by the breakdown of extra red blood cells in the newborn's body - a normal occurrence in the first week of life.  The destruction of these cells by the baby's liver causes a yellow-coloured substance called bilirubin to form in the blood. 

Seeing this yellowish colour in your baby's eyes or skin will prompt your doctor or midwife to order a bilirubin blood test.

"The visual assessment is not perfect, but it alerts mom and the caregiver that the baby is jaundiced," notes Hadad. In some cases, the only indication that the baby may be jaundiced is sleepiness, less vigorous feeding and significant weight loss.

Most babies who develop jaundice will get a mild form - called physiological jaundice - that typically begins after the first 24 hours of life and peaks at four to five days of age before subsiding. You will be advised to feed your baby often to help break down the bilirubin, even if he or she seems more sleepy and slower to feed.

Hadad explains that newborn jaundice causes two worries for doctors, with the first being feeding difficulties: "Significant jaundice in the week of life can be associated with poor breastfeeding that can lead to abnormal weight loss and dehydration."

The second concern is for babies that develop extremely high bilirubin levels. Although very uncommon, these can result in a rare neurological problem called kernicterus, when the bilirubin builds up in the baby's brain. Kernicterus can cause permanent damage and hearing loss.

What causes jaundice?

Most jaundice in babies is caused by the normal, physiological break down of red blood cells. However, baby's chances of developing jaundice go up if she or he is born before 37 weeks or the baby's blood type is different from the mother.  If the baby's sibling had jaundice as a newborn, that's also an indication of greater likelihood.

In addition, bruising from the delivery makes jaundice more likely, as does an infection in the baby's body. A genetic blood enzyme problem called G6PD deficiency can also present as newborn jaundice. It's almost always seen in males - children of Asian, African, Middle-Eastern or Mediterranean heritage are more likely to have G6PD.

Hadad points out that jaundice in the first 24 hours of life, or significantly high levels of bilirubin at any point of your baby's early life, are always a cause for concern and further investigation.

Treatment

Treatment for newborn jaundice depends on the level of bilirubin in the baby's blood after the jaundice is discovered, and whether the level continues to rise. In most cases, it's a matter of encouraging the baby to feed and waiting for the jaundice to run its normal course, while looking out for signs of unusual weight loss or other indications that the baby is not getting enough nutrition or becoming dehydrated.

A repeat bilirubin test will indicate if the bilirubin is decreasing normally. For babies with higher levels of bilirubin, a special light treatment called phototherapy, which can be given at home or in the hospital, is used to help break down the bilirubin. In rare, severe cases, the baby may need an exchange blood transfusion.

Here baby Serena is wearing a biliband to protect her eyes while receiving phototherapy treatment  in the BC Women's Newborn ICU.  Serena is pictured above with her mother attending to her at her bedside.

Screening babies at higher risk

At BC Women's, babies at higher risk for developing jaundice receive a routine bilirubin test at the same time as the normal newborn screening heel-prick test that's done routinely at 24 hours old.  All premature babies, and any baby with another risk factor are screened. This includes babies that have the potential to have a different blood group than their mother and baby boys of East Asian heritage.

What should parents look out for?

All parents should be vigilant for the visual signs of jaundice, as well as a baby who is more sleepy and less interested in feeding.  As physiological jaundice peaks at about four to five days old, Hadad advises parents to ensure that baby is checked by a community health nurse or other caregiver at that time.

Also, don't be afraid to pick up the phone or visit a doctor at any time if: you think your baby is becoming jaundiced; the yellow colour is increasing on a jaundiced baby's skin; or the baby is unusually sleepy and is not waking up for feedings eight or more times a day.

For more information

BC Women's pamphlet on Jaundice

Healthlink BC
 

This article was written by Anne McLaughlin and reviewed by Dr. Keyvan Hadad, Medical Director of the Intermediate Nursery at BC Women's Hospital.

 


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