Jaundice

Jaundice (jawn-diss) is the name for yellowing of the skin and the whites of the eyes. It is very common for newborn babies to get jaundice. In most cases it is harmless and goes away without needing treatment by the time your baby is about two weeks old.

Sometimes jaundice can be serious and may be caused by a medical problem. Serious cases of newborn jaundice are more common in babies born premature. Because it can sometimes be serious, your midwife or baby’s doctor needs to know if they have jaundice. Your baby can then get any treatment they need quickly.

What causes jaundice?

The yellow colour is caused by a build-up of a substance called bilirubin (billy-roo-bin).

Bilirubin is a normal body chemical, which is produced when red blood cells are broken down and replaced by fresh cells. Bilirubin is then processed by the liver and leaves the body in urine (pee) and stools (poo).

Jaundice is common in newborn babies because the baby’s liver is not developed enough in the first few days to process all the bilirubin that is produced. Bilirubin then builds up in the blood, which causes jaundice.

Doctors call this ‘physiological jaundice’, which means it is not caused by a medical problem. This is the most common type of jaundice and starts at about two days after birth, but is usually gone by about two weeks.

Other types of jaundice

Other types of jaundice may be caused by serious medical problems. Jaundice that occurs within the first 24 hours of life, which doctors call ‘early jaundice’, could be caused by conditions such as:

• The mother and baby having different blood types (Rhesus disease)
• Severe infection (Sepsis).

There is also a type of jaundice which causes babies to be jaundiced for longer (after they are around two weeks old). This is called ‘prolonged jaundice’. It can also be referred to as ‘breastmilk jaundice’ because it is much more common in babies who are fed with their mother’s milk.

Doctors are not sure why this happens, but it does not harm the baby and will go away without treatment. This type of jaundice can sometimes carry on for up to 12 weeks, but this does not mean that feeding with breast milk should stop.

Prolonged jaundice is usually harmless, but may occasionally be caused by more serious medical problems. Babies with prolonged jaundice will usually have some extra blood tests to look for any medical problems. This is often at a clinic in the hospital or may be done at home by a community midwife in some areas.

In most cases, no medical condition is found and the jaundice gradually goes away without needing treatment, but occasionally important medical problems are picked up by these tests.

Which babies are most likely to get newborn jaundice?

Jaundice in newborn babies is very common, but in most cases is not severe enough to need treatment. There are some things which make a baby more likely to have jaundice that needs treating:

• Being born premature (less than 38 weeks) – the earlier a baby is born, the more likely they are to need treatment for jaundice.
• Having a low birth weight.
• Being male.
• Being from an Asian or Black family.
• Getting jaundice in the first 24 hours after birth.
• Having a brother or sister who needed treatment for jaundice after birth.
• Being only fed with breastmilk.

Babies born prematurely are more likely to get jaundice. If they have jaundice, it is more likely to be severe and tends to last longer than in full term babies.

After your baby is born, they will be examined, both in hospital and at home. Every time your baby is examined, your care team will be checking for jaundice. You will be encouraged to check your baby too, especially after you take them home. If your baby has jaundice, their skin and the whites of their eyes will appear yellowish.

Signs of jaundice in babies with darker skin tones

It can be more difficult to tell if a baby has jaundice if they have darker skin, because the yellowing may be less obvious. Gently pressing on the tip of their nose or on their forehead can make it easier to see any yellowing.

The whites of the eyes should normally always be white, no matter how dark your baby’s skin. So checking your baby’s eyes is a good way to look for jaundice. It is best to check your baby in bright light, preferably daylight.

Tell your midwife, health visitor, or GP the same day if you think your baby has jaundice.

Jaundice on the neonatal unit

Jaundice is commonly seen on the neonatal unit, especially with preterm babies. Around 80% of preterm babies develop jaundice. The liver of a preterm baby is still developing, and is not yet able to process bilirubin as easily as term babies.

Preterm babies are also more sensitive to the potential complications of jaundice, so treatment often starts earlier than in babies born at full-term.

Jaundice is also more common in babies who are born at full-term but unwell, for example with an infection, or who have other risk factors. Their care team will know what to look out for and will check your baby’s bilirubin level, but if you think your baby looks like they have jaundice, please mention this to them.

If you notice your baby has jaundice

If you think your baby may have jaundice, tell your midwife, health visitor or doctor straight away. Jaundice is not usually a serious problem, but it is best to get your baby checked.

If your baby’s jaundice does not go away (prolonged jaundice)

In full-term babies, jaundice usually goes away on its own by the time your baby is two weeks old, or three weeks if they were premature. If the jaundice does not go away, it might mean that there is an underlying medical problem.

If your baby has jaundice for more than two weeks, tell your midwife, health visitor or GP the same day. Prolonged jaundice is usually harmless, but it is important to have your baby checked in case they need treatment for a medical problem.

Pale stools (poo) and dark urine

A newborn baby’s stool should be yellowy orange and their urine should normally be colourless or yellow. If they are not, that can be a sign of a problem which needs to be investigated.

If your baby has pale (cream or white coloured) stools then you should inform your Community Midwife, GP or Health Visitor immediately, and tests should be arranged that day.

Useful guide to baby stool colour (PDF).

When your baby needs immediate medical help

Get immediate medical help by contacting your GP or going to the hospital Accident and Emergency department if your baby:

• Has jaundice in the first 24 hours after they are born.
• Has jaundice and is unwell, becoming more drowsy or not feeding.
• Is becoming more and more yellow.

What tests might my baby have?

To accurately check whether your baby has jaundice, the level of bilirubin in their blood needs to be measured. Your midwife may be able to do this test at home, or you may need to take your baby to the hospital. If you are on a neonatal unit, doctors and nurses will check your baby’s bilirubin level regularly.

The two main ways to check your baby’s bilirubin level are:

• By using a small device called a bilirubinometer (billy-roo-bin-ometer), which shines a light onto your baby’s skin.
• With a blood test from a heel prick. This may be needed depending on the results of the bilirubinometer test and the age of your baby.

The results of the test are used to see whether your baby needs any treatment. The doctor may also recommend further tests to look for other causes of jaundice. If so, they will explain what these tests involve.

Most babies with newborn jaundice do not need treatment. If your baby does need treatment, this will usually be given in hospital, but sometimes it can be given at home. Some people believe that sunlight is a good treatment for newborn jaundice but this is not correct.

The main treatment for newborn jaundice is called phototherapy. This is where your baby lies in an incubator with a blue light source above them. Some babies may be able to have phototherapy by lying on a special light-up blanket (called a ‘biliblanket’) instead. The blue light changes the bilirubin into a form that your baby’s body can more easily process.

You will usually still be able to feed your baby, change their nappies, and give them a cuddle. Find guidance on how you can be more involved in your baby’s care on the unit.

Preterm babies may need multiple treatments over a number of days and sometimes weeks. The more preterm your baby is, the more likely it is they will need phototherapy. Once treatment has stopped, your baby's bilirubin level will be checked again as they may require more phototherapy.

Very occasionally, a baby with jaundice needs a treatment called exchange transfusion. This is where your baby’s blood is slowly replaced with blood from a blood donor, to remove the bilirubin. This treatment will happen in a neonatal unit and will only be done if your baby’s bilirubin level is very high, or if phototherapy has not worked.

Your baby may need other treatments if they have a medical condition causing their jaundice. You can ask your nurses or doctors to explain what these involve.

Most newborn babies who have jaundice are not ill, and the jaundice goes away on its own in a few weeks without causing any problems.

But high levels of bilirubin can be harmful. That is why some babies need treatment. Fortunately, treatment usually works well to bring down the high level of bilirubin before it causes harm.

In a small number of babies, levels of bilirubin go very high. This can affect the brain and cause a condition called kernicterus (ker-nic-ter-us). Babies with this condition will be very unwell and will need care in the neonatal intensive care unit (NICU). Signs of kernicterus include:

• Being overly sleepy
• Being irritable
• Being floppy, or stiff with an arched back
• Having pauses in breathing (apnoea)
• Having unusual movements (seizures)

Kernicterus can lead to long-term problems for babies. These include seizures (fits), learning difficulties, and hearing problems. If your baby has had kernicterus, they will have follow up appointments to check their development.

If jaundice is caused by a baby having a different blood type to their mother (Rhesus disease), this can also cause the baby to develop anaemia (ah-nee-mee-ya), which is when they have less healthy red blood cells.

It is natural to feel worried if something seems wrong with your baby. Your midwife, health visitor, or your baby’s doctor will be able to talk to you about newborn jaundice. In most cases they will be able to reassure you that your baby’s jaundice will get better without causing problems.

If your baby needs treatment, you can talk to the nurses and doctors in the hospital. If you are unsure about any part of your baby’s diagnosis, treatment or care, just ask.

If you feel like you are struggling, we have lots of information and tips on how you can look after yourself and find support.

If your baby is found to have an underlying liver problem, you may find it helpful to visit the website of the Children’s Liver Disease Foundation. We also have some other links to charities and organisations who can provide support.

If you need someone to talk to, you can contact us on [email protected] or arrange a video call with one of our volunteers.