Jaundice is very common in newborn babies during their first week of life. Here we ask Dr Dionysios Alexandrou, Consultant Paediatrician and Neonatologist to explain what jaundice is and why it is so important that this condition is spotted and managed as early as possible.
What is jaundice?
Jaundice is a yellow discoloration of the skin and the white of the eyes. It is very common in newborn babies, occurring in approximately 60% of term and 80% of preterm newborns. It is caused by high levels of a yellow-coloured pigment of red cells, called bilirubin.
How is jaundice caused and how might it affect a newborn baby?
Normal newborns need to remove the excess red blood cells they are born with, and so they produce high levels of bilirubin. This process, in combination with an immature liver function, can sometimes result in an excess of bilirubin in the blood.
For most normal term babies jaundice is of little or no consequence. However, this is a condition that must be closely monitored as the potential remains for the development of kernicterus, a form of brain damage that can cause death or long-term sequelae, including cerebral palsy and hearing loss.
The estimated incidence of kernicterus is exceedingly rare in full-term babies (0.4-2 per 100,000), but not all babies in the nursery are full term, and those born below 37 weeks of gestation are at higher risk, because their average bilirubin concentrations are higher and occur later, when the baby is already discharged home.
How can I monitor my baby for jaundice?
It is important to closely monitor newborn babies for jaundice. Jaundice during the first 24 hours of life is abnormal and needs urgent management.
The pattern of jaundice is different for bottle and breast-fed babies. Bottle-fed babies usually become significantly jaundiced at 2-3 days after birth. Breast-fed babies can become significantly jaundiced later, at 4-5 days after birth, and therefore they are at higher risk after they are discharged home. All babies should have cleared their jaundice by the end of their first week to 10 days.
We use a non-invasive method called Bilicheck when we measure bilirubin levels in newborn babies at The Portland Hospital. This gives an instant diagnosis without the need to draw blood from a baby.
How is jaundice detected?
The easiest and simplest way to detect jaundice in a newborn is by blanching the skin with digital pressure. Jaundice is initially visible in the face, progressing to the rest of the body from top to bottom with increasing severity, finally reaching the palms and soles of the feet. However, this visual estimation of the severity of jaundice is highly inaccurate and unreliable, therefore, if you suspect something is wrong be sure to contact a consultant.
What are the symptoms and consequences of jaundice?
The vast majority of normal babies with jaundice do not have any symptoms. When jaundice becomes progressively more severe, babies then tend to become sleepy, do not feed well and eventually become irritable. A baby should never be allowed to have such a high level of bilirubin in their blood, as it is toxic to the brain and can cause kernicterus which, though exceedingly rare in full-term newborns, is devastatingly severe and can cause irreversible brain damage.
How is jaundice treated?
A high level of bilirubin is usually treated with phototherapy, which involves placing the baby under blue lights, specifically designed to treat jaundice. Phototherapy helps newborns to clear the excess bilirubin in their body by converting it to a less toxic, water-soluble form that is easily excreted in the urine and stools. Babies with severe jaundice, on rare occasions, need to be treated with an exchange blood transfusion, but this is an invasive procedure only reserved for extremely severe cases.
For more information on jaundice or to book an appointment with Dr Alexandrou please contact The Portland Hospital on 020 7390 8020 or email firstname.lastname@example.org