What is Jaundice?

Jaundice is a yellow colouration of the skin caused by high levels of bilirubin; it is also sometimes called neonatal hyperbilirubinemia or neonatal icterus.

Who is affected and what are the risk factors?

Many babies will have jaundice for at least a few days or weeks after birth. About 80% of preterm babies have jaundice during the first few days of life.

What is the cause?

Bilirubin is a yellow-organge pigment and “waste product” – a chemical derived from the breakdown of haemoglobin (the molecule in red blood cells that carries oxygen) and released into the blood from red blood cells. In older infants or adults, bilirubin is dealt with by the liver. However, many newborn babies have immature systems to deal with bilirubin. These take several days to start to work and bilirubin accumulates until they do. For a few babies, red blood cells break down more easily than normal, for example in preterm babies, in the presence of infection, and when there is blood group incompatibility between mother and her baby.

Despite these important causes most babies who become jaundiced have no underlying problem and once the systems to deal with bilirubin start to work the jaundice settles.

How is it diagnosed?

Although the level of jaundice that is treated can easily be seen by eye, the clinical team will frequently measure the level of bilirubin in the blood to guide their treatment. In some situations they will also use a light meter on the skin, called a bilirubinometer.

If jaundice appears early (in the first day), is very high or lasts a long time then the doctors will look to see if there is a serious underlying cause.  This usually involves taking blood or urine samples. Sometimes a liver ultrasound or more complicated tests may be necessary but your doctor will explain this to you.

How is it managed?

Most babies who become jaundiced need no treatment.  Where the bilirubin levels become high, the most common treatment for jaundice is blue light therapy. It helps to convert bilirubin into a form that is excreted in the urine. During the therapy, babies only wear a nappy to maximise the surface of the skin exposed to the light. Soft shields or pads are placed on the baby’s eyes to protect them from damage. The baby’s blood is usually tested at specific time points to check if the level of the bilirubin is decreasing.

In rare cases of severe jaundice, it may be necessary to perform a blood exchange transfusion. In this procedure, the baby’s blood is removed and immediately replaced with compatible donor blood. However, exchange transfusions are performed very infrequently compared to the past because phototherapy is generally very effective and the important causes are picked up early and treated.

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