Jaundice in A Baby | “Should I Worry?” A Complete Guide For New Parents

How Does Jaundice Occur?

Bilirubin is a yellow-orange pigment naturally produced by the liver during the breakdown of blood cells.

If the baby’s liver has not yet reached maturity, this process may be slowed down. As a result, she may have an excess of bilirubin in her bloodstream, thus rendering her with the tell-tale yellow hue.

Physiological jaundice is the most common jaundice in a baby. It typically manifests on the second or third day of life and settles over the next 7 – 10 days.

Treatment usually consists of phototherapy (more about that below), and it has no permanent effects. 

Jaundice may also be caused by pathological reasons.

Pathological jaundice is more worrying since it could be an underlying symptom of a serious medical condition. 

Pathological jaundice can occur when:

I Am A Permie!

Premature babies need specialised medical care since their organs, especially the liver, would be immature at birth. Usually, a stay in the Neonatal Intensive Care Unit (NICU) is the standard protocol for premies. 

Premies invariably have immature livers, which explains why jaundice is, more or less, a given.

Treatment

Phototherapy is the usual treatment for newborns diagnosed with jaundice. Its aim is to expose the baby to as much light (but not sunlight), as possible.

With phototherapy, a process called photo-oxidation occurs. Photooxidation adds oxygen to the baby’s body. When that happens, the bilirubin in her blood can dissolve in water. This, in turn, makes it easier for her liver to break it down, and then, excrete it out. 

Based on her bilirubin levels, baby’s Paediatrician will chart out her treatment, and keep a close eye on her progress. In the ensuing tests, if her bilirubin levels decrease, and the baby is stable, she can be discharged. 

Breastfeeding Jaundice & Breast Milk Jaundice

Aimee, another contributor at Motherhood Story has written at length about this. To know more, you can read it here.

Incompatible Blood Type

Babies inherit their blood type, and Rhesus factor, from either parent. As such, it is not uncommon for baby’s blood to be different from Mum’s. Most times these differences have no effect on the pregnancy, or baby’s health.

Rhesus Factor Disease (RhD)

However, a complication known as the Rhesus Factor Disease (RhD) occurs when Mum’s Rhesus factor is negative, while the baby is positive.

When that happens, antibodies in Mum’s blood identify baby’s blood cells as enemies and mount an attack against them. To complicate matters, these antibodies, through Mum’s blood, can cross the placenta, and continue to destroy the baby’s blood cells even after birth.

When that happens, the baby may become anaemic. Jaundice is one of the symptoms of anaemia.

Treatment

Doctors routinely test Mum’s blood during pregnancy. In doing so, they will be able to diagnose RhD fairly early on in the pregnancy. If detected, your Gynaecologist will prescribe anti-D immunoglobulin injections to ensure your antibodies do not attack baby’s blood cells.

RhD usually occurs in subsequent, rather than first pregnancies, since by then, Mum’s body would be sensitised to the presence of Rh-positive blood cells. The body is usually not sensitised at the first pregnancy.

Bruising At Birth

Birth can be a traumatic experience for a baby. While rare, there are times when bruises occur.

Bruising occurs when blood vessels burst, and the leaking blood collects under the skin, appearing as a blue/black mark. 

Bruises or a large area of bruising can cause high levels of bilirubin, which, in turn, can bring about jaundice.

Common reasons for bruising may include:

• Large babies, weighing over 3.6kg, 
• Premies, due to their delicate, and sensitive skin,
• Babies with cephalopelvic disproportion, where baby’s head is bigger than Mum’s pelvic area, 
• Breech births, and
• Forceps delivery

Baby’s Paediatrician will administer, and monitor treatment until baby is fit for home.

Biliary Atresia

Biliary atresia is rare, but a serious liver condition. 

Symptoms of this disease appear around the 2nd to the 8th week after birth. Jaundice is a symptom, along with dark urine, pale stools, weight loss, and irritability.

Other than breaking down blood cells, the liver also detoxifies the body by acting as a filter. To do so, the liver secretes bile.

Bile is essential in the digestion of fats found in breast milk, or formula. When bile production and its ongoing processes are smooth, the baby absorbs her essential nutrients. The waste is then excreted through her stools.

With biliary atresia, bile flow, from the liver to the gallbladder is blocked and builds up over time. Unchecked, this can cause serious damage to her liver, leading to scarring of the liver cells (cirrhosis), and eventually, liver failure.

Treatment

Because it is such a serious condition, corrective surgery, or a transplant, may be required.

The chart above is helpful in assisting parents to identify jaundice through urine and stool colours. With close monitoring, quick action and medical help, the baby’s condition may be diagnosed and treated in time.