JAUNDICE IN THE NEWBORN

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Jaundice is the name given to the yellowing of the skin and the whites of the eyes. The pigmentation is due to the deposition of a pigment called Bilirubin, which is normally circulating in the blood of babies, children and adults. The deposition in the white of the eyes and skin occurs when the circulating Bilirubin pigment is excessive. Newborn babies produce large quantities of this pigment. The liver normally processes the Bilirubin pigment. Subsequently, the unrequired pigment is excreted out of the body through the faeces.

In newborn babies is of common occurrence in the first 2 weeks of life. As many as 50% of babies born after 37 weeks of pregnancy will show jaundice but only very few of them would require treatment. The proportion increases to 80% in babies who are born prematurely. Furthermore, Babies who are breastfed exclusively are more likely to develop jaundice compared to babies who are formula fed.

It is usually harmless and clears up on its own within the first 2 weeks of life. Most babies who develop jaundice do not need treatment. However, few babies will develop very high levels of Bilirubin, which can be harmful if not treated. In rare cases, it can cause permanent hearing impairment and or brain damage. The treatment for jaundice using special lights (Phototherapy) is very effective and safe.

Requiring treatment is more likely to occur in the following babies:

Babies who are born early (at less than 37 completed weeks of pregnancy).
Babies who have a brother or sister who had jaundice that needed treatment.
Babies in whom the jaundice is clearly visible in the first 24 hours after birth.
Babies who have a significant difference in their blood group and mother’s group.
Babies who have inherited certain blood or liver disorders.

The above groups of babies are at high risk of Jaundice and are more likely to be re-admitted the following discharge or may require readmission following a hospital course of phototherapy. Nevertheless, babies with no risk factors may still develop significant jaundice necessitating treatment. The usual test for babies at high risk is a blood test for Bilirubin soon after birth.

Jaundice is tested using one of two ways – the usual screening test is done by estimating the Bilirubin level through the skin of the baby. This is called Transcutaneous Bilirubin. It is a painless procedure and helps the nursing and medical team to decide if the baby requires further testing. The majority of babies are managed by using this method if the level is safe. The other test is a laboratory measurement of Bilirubin by a blood test. The blood test is not required if the skin test is reassuring. This is the case in the majority of babies. If a blood test is needed, it could be done by a heel brick. The skin test may be repeated before the baby’s discharge. Babies who are visibly yellow in the first 24 hours of life would require a blood test in addition to the skin test. All babies will be scheduled for a Bilirubin skin test at around 24 hours of age and a further one before discharge. The nursing team will communicate the results to the parents. It is a good practice to ensure a safe Bilirubin level before discharge. Some babies require a follow-up check very soon “within 6-12 hours” but the majority would require an appointment for a Bilirubin skin test within 48-72 hours of discharge.

Phototherapy Treatment

Jaundice treats by special light called Phototherapy. The medical and nursing staff will explain to the parents about phototherapy and other measures to treat Jaundice. The benefits and precautions will be discussed and all questions will be answered. Many babies would remain next to their mothers while the special light is used. Breastfeeding mothers should be able to continue feeding their babies and they will be supported by the midwifery team. During Phototherapy the baby will be placed naked on his or her back. The special lights do not cause pain or distress to the baby. The baby’s eyes will be protected and given routine eye care. The baby may be nursed in a cot or an incubator. The nursing staff will monitor the baby’s feeding, hydration and temperature. The Phototherapy treatment may be stopped from time to time for up to 30 minutes to enable the parents to hold, feed and cuddle their baby, and change the nappy. Breastfeeding or formula feeding normally continues during the phototherapy sessions. The level of Bilirubin is monitored at intervals to check if the phototherapy is effective. The initial test will be every 3–6 hours then 6-12 hours. In very cases, the baby’s blood may need to be exchanged in addition to the phototherapy. The baby is admitted to the neonatal unit if blood exchange is required. This is of very rare occurrence., jaundice does not cause any long-term problems for the vast majority of babies even those requiring treatment. In very few cases, the amount of bilirubin in a baby’s blood is so high that it can damage parts of the brain including parts that affect hearing, vision and movement. The prompt treatment reduces the risk of these complications.

It may appear for the first time or recur following discharge from the hospital. Exposing the baby to direct sunlight may harm the baby and gives the parents a false sense of security. It is highly recommended to bring the baby to the hospital if the parents are worried about jaundice following discharge from the hospital.