When to Worry About Jaundice Symptoms in Newborn Babies

It's natural as new parents to worry about anything out of the ordinary with your newborn child. So when you notice that your baby has jaundice – characterised by a yellowish tinge to their skin and whites of the eyes – it's natural to be worried. Learn the facts behind this common condition to alleviate your fears about newborn jaundice so you know what's normal and when to seek medical help.

What is newborn jaundice?

The yellow tint to your baby's skin and eyes is a sign that there's too much bilirubin in your baby's blood. This condition, known as hyperbilirubinaemia, commonly occurs in babies as early as the second day after birth. In mild cases, the condition usually goes away on its own.

What is bilirubin?

Bilirubin is a yellowish substance found in bile, a fluid that is found in the liver. It is produced when red blood cells break down, and is naturally excreted. However, when the liver is unable to process it, bilirubin can leak into the blood.

If bilirubin levels are within a normal range for a newborn baby, the paediatrician will allow your baby to be discharged.

Symptoms of newborn jaundice

Early signs of newborn jaundice include:

• a yellowish tinge in the skin and whites of the eyes, usually starting in the face and spreading downwards across the body
• skin that looks yellow when light pressure is applied

Symptoms of severe jaundice, which may indicate an underlying medical condition, include:

• signs of jaundice that spread or become more intense
• deepening of the yellow colouring
• fever of over 38 degrees Celsius
• poor appetite
• listlessness or lethargy
• high-pitched crying

Severe jaundice also heightens the risk of bilirubin passing into the brain, which may lead to permanent brain damage.

What causes newborn jaundice?

The moment your baby starts breathing after birth, the excess red blood cells they had while in the uterus start to break down. This generates higher levels of bilirubin. In the first few days of life, your baby's liver is immature and doesn't yet have the ability to excrete this bilirubin properly, so the skin takes on the signature yellow tinge of jaundice.

The colour usually deepens in the first 5 days before it gets lighter and clears up in 1 – 2 weeks. This normal condition is known as physiological jaundice.

Other causes of newborn jaundice

• premature birth (below 37 weeks' gestation)
• insufficient supply of breast milk or formula
• incompatible blood type with the mother
• bruising or internal bleeding at birth
• liver problems
• infection
• enzyme deficiency

When to worry about newborn jaundice

Most cases of jaundice usually resolve on their own. However, if the jaundice-causing bilirubin levels spike within 24 hours of birth, or stay high after a week, other health problems have to be considered.

Complications of newborn jaundice

• infection in the blood stream
• viral infections
• abnormality of enzymes
• liver problems
• biliary artesia (leads to blockage of bile ducts)
• kernicterus (a condition that causes brain damage, can develop if jaundice is left untreated)

Most cases of baby jaundice are physiological and should clear up on their own. However, your baby will be checked by a doctor within a week as part of the routine post-natal check-up. This is when your paediatrician will be able to assess your newborn's condition and advise if additional treatment is necessary.

In the meantime, seek immediate medical attention if you notice the following symptoms:

• Your baby's skin is getting more yellow after 3 days
• Your baby's chest or abdomen is yellow
• Your baby is sluggish and doesn't nurse or feed well
• Your baby's bowel movement is pale.
• Your baby is cranky
• Your baby arches his or her back
• Your baby's cry takes on a high pitch
• The jaundice has not gone away after 2 weeks from birth

How is newborn jaundice treated?

*for illustrative purpose only

Mild jaundice goes away after 1 or 2 weeks as a baby's body gets rid of the extra bilirubin on its own. It is important that your baby feeds well because this encourages bowels movements that allow your baby to excrete the bilirubin through the intestines. Your doctor may advise that you give additional formula beyond breastfeeding to ensure this.

If your baby's bilirubin levels are much higher than normal, 2 types of treatment may be recommended to quickly reduce them to safe levels:

Phototherapy

Phototherapy treatment is done by exposing your baby to a special light to treat the jaundice. This treatment allows the skin to absorb the light, which changes the make-up of the bilirubin so that your baby can more easily expel it from their body.

Blood transfusion

If your baby's jaundice is caused by a health issue, such as incompatible blood type with the mother, your doctor may recommend a blood transfusion or other treatment options.

Other treatments for mild jaundice

If your baby's levels are not considered elevated enough for hospitalisation, other treatment options may include a jaundice vest or BiliBlanket, which is a portable phototherapy device that can be used at home.

You may have heard that babies with jaundice can be placed out in the sun as a way to treat jaundice. Avoid doing so as this exposes your child to potentially harmful UV rays from the sun that can do more harm than good. Your baby requires a special type of UV light in controlled surroundings to treat the condition safely. This usually takes place in the hospital's nursery.

How to prevent newborn jaundice?

You can help to prevent newborn jaundice or prevent it from becoming severe by ensuring your baby is well fed in the days following their birth. This is both to prevent dehydration and to allow the bilirubin to pass through their body more quickly. Aim to feed your baby every 2 to 3 hours.

At the end of the day, you can put your mind at ease that newborn jaundice is a common occurrence. All you need to do is be aware of the warning signs that something may not be right and know when to seek medical help.