JAUNDICE IN NEWBORN BABIES

Jaundice means the yellowish discoloration of the skin and eyes. It occurs due to the high blood level of a substance called “bilirubin”. In older children and adults, jaundice is usually due to a liver disease. However, newborn babies, who develop jaundice, usually have a normal liver. Jaundice is a very common problem in newborn babies. Approximately 60% of full-term and 80% of premature babies develop some amount of jaundice in the first week of life, and about 10% of breast-fed babies are still jaundiced at 1 month of age. We have tried to answer some Frequently Asked Questions (FAQ’s) by mothers- related to jaundice in newborn babies.

1. How do I know that my baby has jaundice?

You can identify jaundice in your newborn baby by yellowish discoloration of the skin. You can press on the skin over your baby’s forehead; tip of the nose; breast-bone of the chest or palms and soles and then release it to see the yellowness.

2. Is my baby’s jaundice always a cause for worry?

No, in most instances jaundice in newborn babies is not a cause for worry. Mild jaundice is actually a normal phenomenon. Mild jaundice usually appears on the second or third day of life, reaches its peak intensity within another two or three days and disappears by about a week or 10 days of life. Mild jaundice causes yellowness limited to the face and chest. There are only a few situations where jaundice is a cause for worry.

3. Okay, so what is the cause for worry?

Very high levels of jaundice can cause permanent brain damage, if not treated in time. This risk is highest in the first couple of weeks of life and decreases thereafter. The risk of brain damage is higher among premature babies, sick babies and with certain kinds of mismatch between the mother’s and baby’s blood groups. Brain damage due to jaundice can result in deafness and problems with controlling body movements. Some forms of severe jaundice can permanently damage the liver by blocking the flow of bile.

4. How will I know that my baby’s jaundice is in the worrisome category?

There are a few danger signs of jaundice which all parents should be aware of. Your baby could be in danger if:

• S/he develops jaundice starting from the first day of life
• Not just his/her face and trunk, but even the palms and soles look yellowish
• S/he becomes sluggish, does not feed properly or develops a shrill cry
• His/her jaundice does not settle within two weeks
• His/her urine looks deep yellow and leaves yellow stains on the diapers
• His/her stools looks white or pale yellow

5. I am being discharged home today after my delivery. How do I know that my baby will not develop serious jaundice at home?

If you were in hospital for at least 3-4 days (for example if you had a Cesarean section) and your child specialist said that your baby did not have any jaundice at discharge or that the jaundice has already started decreasing, then it is extremely unlikely that s/he will develop serious jaundice after going home.

However, if you are discharged early (especially so within the first day), your child specialist must perform what is called a “pre-discharge bilirubin”. This is usually a blood test from a heel-prick sample or by using a special device placed on the skin. This detects jaundice even before it is apparent to the naked eye. By looking at the level of “pre-discharge bilirubin” your doctor will either reassure you and ask you not to come back for jaundice; or will ask you to come back within a day or two to re-check the level of jaundice; or will ask you to stay on in hospital.

6. Could my baby be inherently at a high risk of developing severe jaundice?

There are some babies who are at a greater risk of developing severe jaundice. If your baby fits into one of the following categories, s/he may be at risk of developing severe jaundice, however you don’t need to panic because not every such baby will be affected:

• If your blood group is Rh negative and your baby’s blood group is Rh positive. This creates a problem only if one of your previous babies was Rh positive and you did not get an injection immediately after the previous birth to protect your future babies.
• If your own blood group is O and your baby’s blood group is either A or B.
• If your baby is born premature.
• If your baby has a collection of blood under his/her scalp. This usually looks like a soft swelling on one side of the head.
• If your previous baby had jaundice which required medical treatment.
• If your baby does not consume adequate breast milk, especially in the first week of life.
• If your baby’s pre-discharge bilirubin is in a high risk zone

7. A few days after going home, I find my baby looking yellow. Should I go back to my child specialist?

If you have the slightest doubt about the seriousness of your baby’s jaundice, you must go back to your child specialist. Some of the most unfortunate cases of brain damage, which could have been prevented, occurred because the parents (and at times even the general physician) underestimated the level of jaundice and sought specialist opinion very late. Only if you are confident about assessing your baby and your baby does not have any of the high risk factors mentioned above and you are sure that your baby’s jaundice followed the pattern of mild jaundice, you may opt for observing your baby at home without seeking medical advice.

8. If my baby has a severe jaundice, how will it be treated?

Only few babies with jaundice require treatment. The commonest form of treatment is called phototherapy, in which your baby will be placed naked in a cot, below special blue lights. If the jaundice level rises to a dangerous level in spite of phototherapy your doctor may do a blood exchange on your baby. This involves a stepwise removal of your baby’s blood and replacement by donor blood issued by the blood bank.

9. What if my baby’s jaundice is not severe but it just lingers for a long time?

If your baby was born at full term and you feel s/he is looking yellow beyond two weeks of life, you must consult your child specialist. Similarly, if your baby was born premature and looks yellow beyond three weeks of life, you must consult. The vast majority of such babies do not have any serious problem, as a lot of breast-fed babies may remain jaundiced until 1 ½  to 2 months of life and they get well on their own. However, a minority of babies may have obstruction to bile flow, liver disease, thyroid problems and other serious illnesses, which must not be missed.

10. I get a lot of advice from my family members regarding my baby’s jaundice. What should I do?

Jaundice being such a common problem, almost every person has an opinion about it! There are several myths regarding jaundice, which we have tried to dispel below:

• Myth: Jaundice in the baby is caused by what mother has eaten

No… Jaundice in the newborn has no connection with mother’s diet. Mother should continue to consume all normal home-made foods.

• Myth: If mother eats haldi or wears yellow clothes, it worsens baby’s jaundice

No … Eating haldi or wearing yellow clothes has no relation with the baby’s jaundice. Consuming turmeric may in fact be beneficial for the mother’s overall health.

• Myth: The baby develops jaundice because of a problem with the mother’s milk

No… Jaundice in babies does not occur because of any problem with mother’s milk. On the contrary, not feeding enough breast milk in the first week of life may worsen jaundice.

• Myth: Exposing the baby to sunlight treats jaundice

No… For treatment of jaundice special blue light is required. Sunlight does not have sufficient intensity of the required colour to be able to treat jaundice.

 

Prof Sourabh Dutta and

Dr Sunil Jondhale,

Newborn Unit,

Department of Pediatrics,