Health tips: Jaundice in babies

Between 30% to 50% of term babies (babies more than 37 weeks in womb) experience jaundice after birth. This post will share with you more about jaundice and teach you what you can do about it. :)

What is jaundice?

Jaundice is a condition in which the skin and eyes of a newborn baby turn yellow due to high amounts of bilirubin in the body.

Common causes of jaundice in the newborn:

Bilirubin is a breakdown product of red blood cells. High levels of bilirubin in the blood causes jaundice, and at very high levels is harmful to the baby's brain. Immediate symptoms include lethargy, irritability and stiff body and limbs. Long term impact will be brain damage which may result in mental retardation, deafness, cerebral palsy and death.

How to detect jaundice in your baby?

You will notice that your baby (if jaundiced) will have yellow skin and eyes. It may be more difficult to detect jaundice in babies with darker skin colour, however, these babies are not less likely to have jaundice.

1) Physiological jaundice

This is common in term babies and more so in pre-term babies. As their livers are not yet mature and their red blood cells have short lifespan, they have an increased bilirubin load (increased turnover rate of red blood cell) and a low ability of excreting them. The jaundice usually starts on the 2nd and 3rd day of life, peak at 3 to 5 days and return to normal by day 10 of life. There is no treatment for this. Just observe and let nature runs its course.

2) Breast milk jaundice

Breast milk jaundice is the most common cause of jaundice that persists beyond 14 days of life. The jaundice usually starts near the 1st week of life, peak at the 2nd week and can lasts up to 12 weeks. Again, no treatment is required and let nature run its course. Although babies on formula milk are less prone to breast milk jaundice, they are missing out on the nutrients breast milk have as compared to infant formula milk. Hence, do not stop breastfeeding!

3) Poor feeding

Sub-optimal milk intake in babies can cause dehydration which results in slower bilirubin excretion. Weight loss should not exceed more than 10% of the body weight in the 1st week of life.

Other causes include blood group incompatibility with mother, infection, genetic causes, liver inflammation, urinary tract infection, low thyroid hormones and inflammation of the bile ducts.

Things to take note of in your baby:

1) When did the jaundice start?

All babies with jaundice on the 1st day of life is abnormal and will need to be fully investigated in the hospitals.

2) Is your baby having tea-coloured urine or pale stools?

If your baby has white stools or orange/dark brown/tea-coloured urine, do seek help from your doctors.

3) Is your child feeding well?

Normal babies change diapers about 5 times a day. Diaper changing is an indication of your baby’s hydration status. Poor feeding leads to jaundice.

Which types of babies are more at risk of jaundice?

1) Pre-mature babies

2) Babies that have incompatible blood group with their mothers

3) G6PD deficient babies (lacking the enzyme essential for red blood cells to have a normal lifespan, this will lead to an increased turnover of red blood cells)

4) Babies that are exclusively breastfed and have poor feeding

5) Babies with bruises (from a difficult birth or other causes)

Advice on care for babies and common misconceptions

1) It is important to monitor bilirubin levels closely with your doctors.

2) In the past, people have put their babies with jaundice under the sun thinking that it may help. Do not put your baby under the sun as this is ineffective. Only blue light is needed (hospitals use phototherapy with blue or white light). Putting your baby under the sun may cause sunburn and dehydration and may worsen the jaundice.

3) Breast milk is the best for the baby. Do not stop breast feeding, dilute the milk or feed your baby water.

4) Please seek help from lactation consultants from hospitals if you are having difficulties with breastfeeding.

How are babies with jaundice followed up?

Generally, babies with mild to moderate jaundice levels should be followed up with the doctor in primary care. In Singapore, babies are followed up in polyclinics or hospitals. Babies with severe jaundice will be referred to hospitals. The cut off levels of bilirubin for referral to hospitals varies among institutions.

When are babies discharged from medical care?

Generally, babies are discharged when their serum bilirubin levels fall below 100 mmol/L (depending on the practice of the institution). However, parents are encouraged to monitor the child at home and return if the yellowing of eyes and skin does not go away or get worse.

Photograph designed by Photoduet - Freepik

Disclaimer: This article provides general advice for the public. Please seek official advice from your primary physician.