It’s alarming when your newborn turns yellow but over 60% of infants get jaundice. Usually, there’s no need to worry, says paediatrician, Dr Kerry Robinson

There’s your beautiful baby, perfect in every way, but within three days her skin and the whites of her eyes turn yellow. This discoloration is called jaundice and it’s caused by the breakdown of red blood cells. But don’t fret, in most cases it’s physiological jaundice and that’s normal. Though, occasionally, jaundice is a sign of deeper problems, your baby will usually show other symptoms that indicate an illness.

Physiological Jaundice

Two things cause yellow discolouration – an immature liver and an absence of bacteria in the gut.

Newborn babies are born with a surplus of red blood cells and after birth the excess cells are broken down in the spleen. One of the breakdown products of red blood cells is bilirubin, which is responsible for the yellow colour. Bilirubin normally travels in the blood from the spleen to the liver where it is processed with no problems. But many newborns’ livers are immature and can’t process all the bilirubin delivered, thus the bilirubin passes into the gut.

In older children and adults the gut is full of bacteria that break down any incoming bilirubin. In newborns, the gut hasn’t built up enough healthy bacteria (its normal flora) to cope with the bilirubin. So it’s reabsorbed from the gut back into the blood stream making the skin and whites of the eyes go yellow. It doesn’t usually have an adverse effect on any other organs. Though, in extreme cases, the brain can be affected, in this country, treatment for jaundice is started well before there is any danger.

Physiological jaundice usually starts after 48 hours of age, reaching a peak by 4–5 days, and can last for up to two weeks. It’s more common in breastfed babies (although no-one really knows why) but this does NOT mean you have to stop breastfeeding.

If jaundice is present with certain other symptoms, it may indicate another underlying illness.

Things to look out for which suggest it’s not just ‘breast milk jaundice’

• Poor feeding – your baby doesn’t wake to feed and doesn’t seem interested in sucking
• Excessive drowsiness and difficulty waking your baby
• Excessive irritability – unstoppable crying
• Increased muscle tone – your baby feels stiff

If any of these are present, tell your midwife straight away.

What else causes newborn jaundice?

• Babies born prematurely are more likely to become suffer as their livers are even more immature
• Infection – either acquired in the womb or after birth
• Neonatal hepatitis
• Malformation of the bile ducts
• Other red blood cell abnormalities
• Metabolic problems
• Hypothyroidism
• Rhesus disease. This happens when mother and baby’s blood groups aren’t compatible – one is rhesus negative, the other rhesus positive. If, during the pregnancy, blood from the baby crosses the placenta and enters the mother’s blood stream, the mother starts to make antibodies against the baby’s blood. These antibodies can cross over the placenta and can break down the baby’s blood cells. This is a very rare condition but can be fatal.

What if the jaundice starts in the first day of life?

This does usually indicate an underlying problem, so you should take your baby to hospital, if you’re not there already. The most likely causes are an infection or an excess breakdown of red blood cells.

What if the jaundice lasts more than two weeks?

Breastfeeding is still the most common cause for prolonged jaundice, affecting about 15% of healthy breastfed babies. This jaundice usually fades after 3–4 weeks. If the jaundice lasts longer than two weeks, a blood test will be done to exclude other conditions.

Is it dangerous for my baby to be jaundiced?

Not really, as long as your baby is alert and feeding well and the discolouring isn’t too severe. Your midwife will see you regularly and can always take a blood sample to determine the level of jaundice. This is plotted on a graph and if it’s above a certain level treatment will be given.

What’s the treatment?

The most common treatment is phototherapy, which involves placing your baby under special lights. Sometimes sunlight alone will do, but in hospital, blankets are used with built-in lights – a bit like a sun bed.

Light from the blue band of the visible spectrum converts the bilirubin to a harmless soluble breakdown product. Phototherapy is an extremely successful treatment and for most babies it’s all they need to cure the symptoms. If it doesn’t work, the next step is an exchange transfusion, where blood is taken from the baby and replaced with donor blood. This is only done in specialist centres and is very rare.

Can jaundice be prevented?

Not really. Unfortunately, it isn’t something we can screen for. It just has to be noticed, monitored and treated where necessary. So don’t be alarmed if your newborn goes a bit yellowy – it’s extremely common and doesn’t usually cause any harm. If there are concerns, your midwife will refer you to the hospital for phototherapy which is non-invasive, involves no needles and just means treating your baby under lights.