What is neonatal jaundice?

Neonatal jaundice is a condition seen in babies, particularly preterm babies and some breastfed babies. It is caused by excess bilirubin, a yellow pigment found in red blood cells. In most cases, jaundice is a mild, short-term condition with no lasting effects. However, if the baby is not feeding correctly, is dehydrated, or has a shorter-than-normal lifespan for red blood cells, jaundice may be an indication of a problem that requires medical attention.

What are the different types of neonatal jaundice?

Pathological Jaundice

Physiological jaundice is the most common type and usually develops in 2- or 3-day-old babies. It usually resolves itself within two weeks. During this time, your baby's liver becomes capable of removing excess bilirubin from the blood.

Breastfeeding Jaundice

Breastfeeding jaundice is more common with breastfed babies during the first week. It occurs as a result of the baby consuming less milk than usual. This can be due to nursing difficulties in the initial days or insufficient milk production by the mother.

Breast milk Jaundice

Breast milk jaundice is caused by substances in the breast milk that can interfere with how the baby’s liver breaks down bilirubin and can take a month or longer to go away. Lastly, other types of jaundice can occur if the newborn has an unrelated medical condition.

Common Symptoms of Neonatal Jaundice

The first signs of neonatal jaundice are usually the yellowing of the face, the eyes, and the region under the tongue. Depending on the build-up of bilirubin, this can progress to the arms, legs, and feet. While this is the most common form of jaundice and usually resolves itself after five to six days, in some cases the baby's skin can become more yellow earlier than expected, last longer than usual, or be more pronounced. In these cases, a doctor's consultation is necessary to determine if any testing is necessary.

Furthermore, the colour of the baby's urine and stool may also change from a light yellow or dark brown to a light tan or beige. If either of these is observed, it is important to consult with a doctor as soon as possible, as this can indicate the jaundice is due to other pigments.

Causes of Neonatal Jaundice

Excess levels of bilirubin in the bloodstream, known as hyperbilirubinemia, are the primary cause of jaundice. Bilirubin is a normal byproduct released from the breakdown of "used" red blood cells and gives the yellowish hue to jaundice. Newborns typically produce increased levels of bilirubin due to the greater production and faster breakdown of red blood cells in the first few days of life. The immature liver of a newborn is often unable to filter bilirubin quickly, resulting in a surplus of bilirubin and the onset of jaundice.

Other potential causes of jaundice in newborns can include internal bleeding, sepsis, viral or bacterial infections, blood incompatibility between mother and baby, liver malfunction, biliary atresia, enzyme deficiency, or rapid breakdown of red blood cells.

When to See a Doctor and How to Diagnose It?

It is important to consult a doctor before the onset of further complications so that an appropriate action plan can be put into place. The bilirubin level is typically highest between three and five days old, and it is important to check the baby's level again at this time. To accurately determine the level, a transcutaneous bilirubin (TcB) probe may be placed on the baby's head. If the TcB level is high, a blood test is ordered to confirm the results, which show the total levels of bilirubin.

How is neonatal jaundice treated?

If a newborn baby's bilirubin levels are low, no treatment may be necessary since they can self-correct within one to two weeks with regular feeding. However, if the bilirubin levels are high or continue to rise, the baby should undergo phototherapy treatment. During this procedure, the baby will be exposed to special blue lights while wearing only a diaper and a mask to cover the eyes to help the liver rid the body of the excess bilirubin. Phototherapy takes one to two days and is not harmful to the baby. If the bilirubin levels are not too high, light therapy may be done at home.

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

The typical signs include yellowing of the skin, especially on the face, the whites of the eyes, and the region under the tongue. It can further progress to the chest, abdomen, and limbs.

2. Can jaundice have a long-term effect on my baby?

Usually, the bilirubin is broken down by the baby's liver without any harmful effects. However, when left untreated, higher levels of bilirubin can affect the brain.

3. Does jaundice go away naturally in babies?

It can go away in 2–4 weeks after your baby is breastfed or fed with formula.

4. What is the best treatment for jaundice in babies?

Phototherapy is an effective way to break down bilirubin, which causes jaundice. Alternatively, if it's a mild case of jaundice, breastfeeding 10–12 times a day, along with formula, can help decrease bilirubin levels.

5. When to consult a doctor?

You can see the doctor when the yellow colour of the skin doesn't start to fade within a few days of breastfeeding.