Overview

Jaundice is a common and usually harmless condition in newborn babies that causes yellowing of the skin and the whites of the eyes.The medical term for jaundice in babies is neonatal jaundice.

Other symptoms of newborn jaundice can include:

  • yellowing of the palms of the hands or soles of the feet
  • dark, yellow urine – a newborn baby's urine should be colourless
  • pale-coloured poo – it should be yellow or orange

The symptoms of newborn jaundice usually develop two to three days after the birth and tend to get better without treatment by the time the baby is about two weeks old.

Title
Newborn jaundice

Types
Symptoms

Jaundice usually appears about three days after birth and disappears by the time the baby is two weeks old.

In premature babies, who are more prone to jaundice, it can take five to seven days to appear and usually lasts about three weeks. It also tends to last longer in babies who are breastfed, affecting some babies for a few months.

If your baby has jaundice, their skin will look slightly yellow. The yellowing of the skin usually starts on the head and face, before spreading to the chest and stomach.

In some babies, the yellowing reaches their legs and arms. The yellowing may also increase if you press an area of skin down with your finger.

Changes in skin colour can be more difficult to spot if your baby has a darker skin tone. In these cases, yellowing may be more obvious elsewhere, such as:

  • in the whites of their eyes
  • inside their mouth
  • on the soles of their feet
  • on the palms of their hand

A newborn baby with jaundice may also:

  • be poor at sucking or feeding
  • be sleepy
  • have a high-pitched cry
  • be limp and floppy
  • have dark, yellow urine – it should be colourless
  • have pale poo – it should be yellow or orange
When to seek medical advice

Your baby will usually be examined for signs of jaundice within 72 hours of being born, during the newborn physical examination.

If your baby develops signs of jaundice after this time, speak to your midwife, health visitor or GP as soon as possible for advice.

While jaundice isn't usually a cause for concern, it's important to determine whether your baby needs treatment.

Your baby will be checked for jaundice within 72 hours of being born during the newborn physical examination.

However, you should keep an eye out for signs of the condition after you return home as it can sometimes take up to a week to appear.

When you're at home with your baby, you should look out for yellowing of their skin or the whites of their eyes. Gently pressing your fingers on the tip of their nose or on their forehead can make it easier for you to spot any yellowing.

You should also check your baby's urine and poo. Your baby may have jaundice if their urine is yellow (a newborn baby's urine should be colourless) or their poo is pale.

You should speak to your midwife, health visitor or GP as soon as possible if you think your baby may have jaundice. Tests will need to be carried out to determine whether any treatment is necessary.

Visual examination

A visual examination of your baby will be carried out to look for signs of jaundice. Your baby needs to be undressed during this so their skin can be looked at under good – preferably natural – light.

Other things that may also be checked include:

  • the whites of your baby's eyes
  • your baby's gums
  • the colour of your baby's urine or poo
Bilirubin test

If it's thought your baby has jaundice, the level of bilirubin in their blood will need to be tested. This can be done using:

  • a small device called a bilirubinometer, which beams light on to your baby's skin – it calculates the level of bilirubin by analysing how the light reflects off or is absorbed by the skin
  • a blood test of a sample of blood taken by pricking your baby's heel with a needle – the level of bilirubin in the liquid part of the blood (the serum) is then measured

In most cases, a bilirubinometer is used to check for jaundice in babies. Blood tests are usually only necessary if your baby developed jaundice within 24 hours of birth or the reading is particularly high.

The level of bilirubin detected in your baby's blood is used to decide whether any treatment is necessary.

Further tests

Further blood tests may need to be carried out if your baby's jaundice lasts longer than two weeks or treatment is needed. The blood is analysed to determine:

  • the baby's blood group – this is to see if it's incompatible with the mother's
  • whether any antibodies (infection-fighting proteins) are attached to the baby's red blood cells
  • the number of cells in the baby's blood
  • whether there's any infection
  • whether there's an enzyme deficiency

These tests help determine whether there's another underlying cause for the raised levels of bilirubin.

Causes

Jaundice is caused by too much bilirubin in the blood. This is known as hyperbilirubinaemia.

Bilirubin is a yellow substance produced when red blood cells, which carry oxygen around the body, are broken down.

The bilirubin travels in the bloodstream to the liver. The liver changes the form of the bilirubin so it can be passed out of the body in poo.

However, if there's too much bilirubin in the blood or the liver can't get rid of it, excess bilirubin causes jaundice.

Jaundice in babies

Jaundice is common in newborn babies because babies have a high level of red blood cells in their blood, which are broken down and replaced frequently.

The liver in newborn babies is also not yet fully developed, so it's less effective at processing the bilirubin and removing it from the blood.

This means the level of bilirubin in babies can be about twice as high as in adults.

By the time a baby is around two weeks old, they're producing less bilirubin and their liver is more effective at removing it from the body. This means the jaundice often corrects itself by this point without causing any harm.

Breastfeeding

Breastfeeding your baby can increase their chances of developing jaundice. However, there's no need to stop breastfeeding your baby if they have jaundice as the symptoms normally pass in a few weeks.

The benefits of breastfeeding outweigh any potential risks associated with the condition.

If your baby needs to be treated for jaundice, he or she may need extra fluids and more frequent feeds during treatment. See treating newborn jaundice for more information.

The reason why breastfed babies are more likely to develop jaundice is unclear, although a number of theories have been suggested. For example, it may be that breast milk contains certain substances that reduce the ability of the liver to process bilirubin.

Newborn jaundice thought to be linked to breastfeeding is sometimes called breast milk jaundice.

Underlying health conditions

In some cases, jaundice may be the result of another health problem. This is sometimes called pathological jaundice.

Some causes of pathological jaundice include:

  • an underactive thyroid gland (hypothyroidism) – where the thyroid gland doesn't produce enough hormones
  • blood group incompatibility – when the mother and baby have different blood types, and these are mixed during the pregnancy or the birth
  • rhesus factor disease – a condition that can occur if the mother has rhesus-negative blood and the baby has rhesus-positive blood
  • a * urinary tract infection
  • Crigler-Najjar syndrome – an inherited condition that affects the enzyme responsible for processing bilirubin
  • a blockage or problem in the bile ducts and gallbladder – these create and transport bile, a fluid used to help digest fatty foods

An inherited enzyme deficiency known as glucose 6 phosphate dehydrogenase (G6PD) could also lead to jaundice or kernicterus.

If you have a family history of G6PD, it's important to let your midwife, GP or paediatrician know and your baby's jaundice symptoms are closely monitored

Diagnosis
Treatment

You should speak to your midwife, health visitor or GP if your baby develops jaundice. They'll be able to assess whether treatment is needed.

Treatment is usually only necessary if your baby has high levels of a substance called bilirubin in their blood, so tests need to be carried out to check this. See diagnosing jaundice in babies for more information about the tests used.

Most babies with jaundice don't need treatment because the level of bilirubin in their blood is found to be low. In these cases, the condition usually gets better within 10 to 14 days and won't cause any harm to your baby.

If treatment is felt to be unnecessary, you should continue to breastfeed or bottle feed your baby regularly, waking them up for feeds if necessary. If your baby's condition gets worse or doesn't disappear after two weeks, contact your midwife, health visitor or GP.

Prolonged newborn jaundice (lasting longer than two weeks) can occur if your baby was born prematurely or if he or she is solely breastfed. It usually improves without treatment. However, further tests may be recommended if the condition lasts this long to check for any underlying health problems.

If your baby's jaundice doesn't improve over time or tests show high levels of bilirubin in their blood, they may be admitted to hospital and treated with phototherapy or an exchange transfusion.

These treatments are recommended to reduce the risk of a rare but serious complication of jaundice called kernicterus, which can cause brain damage.

Phototherapy

Phototherapy is treatment with light. It is used in some cases of newborn jaundice to lower the bilirubin levels in your baby's blood through a process called photo-oxidation.

Photo-oxidation adds oxygen to the bilirubin so it dissolves easily in water. This makes it easier for your baby's liver to break down and remove the bilirubin from their blood.

There are two main types of phototherapy.

  • conventional phototherapy – where your baby is laid under a halogen or fluorescent lamp with their eyes covered
  • fibreoptic phototherapy – where your baby lies on a blanket that incorporates fibreoptic cables; light travels through the fibreoptic cables and shines on to your baby's back

In both methods of phototherapy, the aim is to expose your baby's skin to as much light as possible.

Conventional phototherapy is the treatment tried first in most cases, although fibreoptic phototherapy may be used first if your baby was born prematurely.

These types of phototherapy will usually be stopped for 30 minutes every three to four hours so you can feed your baby, change their nappy, and give them a hug.

If your baby's jaundice doesn't improve after conventional or fibreoptic phototherapy, continuous multiple phototherapy may be offered. This involves using more than one light and often a fibreoptic blanket at the same time.

Treatment won't be stopped during continuous multiple phototherapy. Instead, milk that has been squeezed out of your breasts in advance may be given through a tube into your baby's stomach, or fluids may be given into one of their veins (intravenously).

During phototherapy, you baby's temperature will be monitored to ensure they're not getting too hot and they'll be checked for signs of dehydration. Your baby may need intravenous fluids if they're becoming dehydrated and aren't able to drink a sufficient amount.

The bilirubin levels will be tested every four to six hours after phototherapy has started. Once levels start to fall, they'll be checked every six to 12 hours.

Phototherapy will be stopped when the bilirubin level falls to a safe level, which usually takes a day or two.

Phototherapy is generally very effective for newborn jaundice and has very few side effects, although your baby may develop a temporary rash or tan as a result of the treatment.

Exchange transfusion

A blood transfusion, known as an exchange transfusion, may be recommended if your baby has particularly high levels of bilirubin in their blood or if phototherapy hasn't been effective.

During an exchange transfusion, small amounts of your baby's blood are removed through a thin plastic tube placed into blood vessels in their umbilical cord, arms or legs. The blood is then replaced with blood from a suitable matching donor (someone with the same blood group).

As the new blood won't contain bilirubin, the overall level of bilirubin in your baby's blood will fall quickly.

Your baby will be monitored throughout the transfusion process, which can take several hours to complete. Any problems that may arise, such as bleeding, will be treated.

Your baby's blood will be tested within two hours of treatment to check if it's been successful. If the level of bilirubin in your baby's blood remains high, the procedure may need to be repeated.

Other treatments

If jaundice is caused by an underlying health problem, such as an infection, this usually needs to be treated.

If the jaundice is caused by rhesus disease (when the mother has rhesus-negative blood and the baby has rhesus-positive blood), intravenous immunoglobulin (IVIG) may be used.

IVIG is usually only used if phototherapy alone hasn't worked and the level of bilirubin in the blood is continuing to rise.

Prevention
Complications

Kernicterus is a rare but serious complication of untreated jaundice in babies. It's caused by excess bilirubin damaging the brain or central nervous system.

In newborn babies with very high levels of bilirubin in the blood (hyperbilirubinaemia), the bilirubin can cross the thin layer of tissue that separates the brain and blood (the blood-brain barrier).

The bilirubin can damage the brain and spinal cord, which can be life threatening. Brain damage caused by high levels of bilirubin is also called bilirubin encephalopathy.

Your baby may be at risk of developing kernicterus if:

  • they have a very high level of bilirubin in their blood
  • the level of bilirubin in their blood is rising rapidly
  • they don't receive any treatment

Kernicterus is now extremely rare in the UK, affecting less than 1 in every 100,000 babies.

Initial symptoms of kernicterus in babies include:

  • decreased awareness of the world around them – for example, they may not react when you clap your hands in front of their face
  • their muscles become unusually floppy, like a rag doll
  • poor feeding

As kernicterus progresses, additional symptoms can include seizures (fits) and arching of the neck or spine.

Treatment for kernicterus involves using an exchange transfusion as used in the treatment of newborn jaundice.

If significant brain damage occurs before treatment, a child can develop serious and permanent problems, such as:

  • cerebral palsy – a condition that affects a child's movement and co-ordination
  • hearing loss – which can range from mild to severe
  • learning difficulties
  • involuntary twitching of different parts of their body
  • problems maintaining normal eye movements – people affected by kernicterus have a tendency to gaze upwards or from side to side rather than straight ahead
  • poor development of the teeth
Risks
Recovery
Living with
Self-help