• Reference Number: HEY-006/2023
• Departments: Maternity Services, Neonates, Paediatrics
• Last Updated: 25 January 2023

Introduction

This leaflet has been produced to give you general information about jaundice in the newborn baby.  Most of your questions should be answered by this leaflet.  It is not intended to replace the discussion between you and your doctor or midwife, but may act as a starting point for discussion.   If after reading it you have any concerns or require further explanation, please discuss this with a member of the healthcare team.

What is jaundice?

Jaundice is a name given to the yellow appearance of the skin and the whites of the eyes. Jaundice is not a liver disease. Jaundice is very common in newborn babies and about nine out of ten of newborn babies will become jaundiced two or three days after birth. Jaundice reaches its peak at about four days of life and then gradually disappears in most babies by the time they are two weeks old. Jaundice does not necessarily mean your baby is ill. It can occur within twenty-four hours after birth, but this is rare. If this happens it is important that you tell your midwife or doctor.

Why did my baby develop jaundice?

When your baby is in the womb the waste products are removed through the placenta. Once your baby is born their own body has to do this. It can take some time for a baby to be able to remove their waste products properly. One of the waste products is called bilirubin. Bilirubin is made when the old red blood cells are broken down. Too much bilirubin will cause jaundice.

Measuring the level of bilirubin can be done very simply for most babies, using a special hand held device placed briefly on the skin (a bilirubinometer).  It will not hurt your baby.  However babies whose bilirubinometer reading is high, babies who are less than 24 hours old and some babies born at less than 35 weeks gestation will need a blood test. This is usually taken from a heel prick.

Can there be any complications or risks?

Newborn jaundice is not usually dangerous and in most cases babies who develop jaundice will not need treatment or extra monitoring.  However, a few babies will develop very high levels of bilirubin, which can be harmful if not treated.  In rare cases, it can cause brain damage.  If there is any doubt, your baby’s bilirubin level will be measured to make certain there is no risk to your baby.

How can you treat jaundice?

Most babies will need no treatment at all and the jaundice will disappear by the time the baby is two weeks old. However a small number of babies do need some treatment. If it is decided that your baby does require treatment for jaundice because the bilirubin level is higher than expected, your baby will be treated in hospital with phototherapy.  Phototherapy involves placing the baby under a special light (not sunlight).  Light of certain wavelength helps the body to break down bilirubin and pass it out of the body. Your baby will be placed naked under the light, with a visor over their face to protect their eyes.  Alternatively your baby may be laid on a “bili-blanket” which also gives off this special light.

The source of the light used will depend on the equipment available and or the bilirubin level. The treatment may be stopped from time to time, for up to thirty minutes, so you can hold, feed, cuddle and change your baby. During the phototherapy treatment your baby’s bilirubin level will be monitored through taking heel prick blood samples.  The results will be measured against a chart to assess if the bilirubin level is decreasing.  Once the level has dropped below the treatment level indicated on the chart the phototherapy will be stopped.  However your baby would need to remain in hospital for a further blood sample to be taken after stopping treatment to make sure the level does not start to rise again.   Phototherapy is generally started well before any dangerous level is reached and can usually be stopped within a few days.

How you can help?

When looking at your baby you should note the colour of their skin in natural light to see if it appears yellow.  A yellowing of the whites of the eyes and the gums are more helpful indicators of jaundice, particularly in darker skin tones, if you are concerned that your baby looks jaundiced speak to your midwife or doctor.  Remember many babies become jaundiced and do not require any extra monitoring or treatment.

Check the colour and frequency of your baby’s poo’s and wee’s in their dirty nappies. The number of wee’s a baby has in 24 hours should match the number of days they are in age i.e. day one,  one wet nappy, day two, two wet nappies.  This is the same until they reach day five, after this they should be passing at least 6 wet nappies a day and the nappies should feel heavier due to an increased volume of wee. The urine of a new born baby should be colourless. If your baby’s urine is persistently yellow you should tell your midwife, doctor or health visitor, whether or not your baby has jaundice. The poo’s of a breast fed baby should be green/daffodil yellow and the stools of a bottle fed baby should be green / English mustard yellow. Your baby should be passing at least two poo’s a day if they are breastfeeding.

As Jaundice can cause babies to be less wakeful, it may be that during this period of jaundice, if your baby is not showing regular cues to want to feed, you will need to stimulate them regularly to do so.  Once the bilirubin has returned to normal level you can return to responsive feeding.

If you are breastfeeding your baby, there is no reason why you should stop because your baby has jaundice.  However, it may be beneficial to have the position and attachment of your baby at the breast observed to check it is correct.  As above you should be encouraged to increase the number of times your baby goes to the breast to feed.  If there is any concern that your baby requires more fluid, then you should be encouraged to express your breast milk for your baby which can then be given after a breastfeed.  If any supplementation beyond your expressed milk is required ie by means of formula milk, then this should be kept to the minimum amount needed and stopped at the earliest opportunity, as to not affect your ongoing milk supply.  We would recommend that any supplementations for a breastfed baby are where possible given by a cup or syringe, in order to minimise any nipple teat confusion.

During treatment for jaundice, you and the staff caring for your baby may find it useful to record your baby’s feeds/poos and wee’s on a chart.

What happens if the jaundice does not go?

Jaundice should normally resolve 2 weeks if baby is bottle fed, and 3 weeks if baby is breastfed. However, if it continues a blood test called “split bilirubin” should be carried out around 3 weeks of age. This test will be done in the hospital. This measures the bilirubin levels in your baby’s blood in more detail. Some babies who are breastfed may have jaundice, which continues. Breast milk jaundice is harmless and will gradually disappear. A small number of babies will have liver disease jaundice – or even both. However it is important that a diagnosis of breast milk jaundice is made after a split bilirubin blood test.

Should you require further advice on the issues contained in this leaflet, please do not hesitate to contact Rowan Ward on 01482 605381 or the community midwifery office on (01482) 382658

Further information can also be found at:

Children’s Liver Disease Foundation

36 Great Charles Street
Birmingham
B3 3JY
Tel: (0121) 2123839
Email: info@childliverdisease.org and www.childliverdisease.org

General Advice and Consent

Most of your questions should have been answered by this leaflet, but remember that this is only a starting point for discussion with the healthcare team.

Consent to treatment

Before any doctor, nurse or therapist examines or treats your child, they must seek your consent or permission. In order to make a decision, you need to have information from health professionals about the treatment or investigation which is being offered to your child. You should always ask them more questions if you do not understand or if you want more information.

The information you receive should be about your child’s condition, the alternatives available for your child, and whether it carries risks as well as the benefits. What is important is that your consent is genuine or valid. That means:

• you must be able to give your consent
• you must be given enough information to enable you to make a decision
• you must be acting under your own free will and not under the strong influence of another person

Information about your child

We collect and use your child’s information to provide your child with care and treatment. As part of your child’s care, information about your child will be shared between members of a healthcare team, some of whom you may not meet. Your child’s information may also be used to help train staff, to check the quality of our care, to manage and plan the health service, and to help with research. Wherever possible we use anonymous data.

We may pass on relevant information to other health organisations that provide your child with care. All information is treated as strictly confidential and is not given to anyone who does not need it. If you have any concerns please ask your child’s doctor, or the person caring for your child.

Under the General Data Protection Regulation and the Data Protection Act 2018 we are responsible for maintaining the confidentiality of any information we hold about your child. For further information visit the following page: Confidential Information about You.

If you need information about your child’s (or a child you care for) health and wellbeing and their care and treatment in a different format, such as large print, braille or audio, due to disability, impairment or sensory loss, please advise a member of staff and this can be arranged.

Your newborn baby’s NHS number

An NHS number is allocated to everyone whose birth is registered with a Registrar of Births and Deaths in England and Wales. You already have an NHS number and your baby will be assigned an NHS number soon after birth. Your NHS number is unique to you and provides a reliable means of linking you to the medical and administrative information we hold about you. NHS numbers are allocated on a random basis and, in themselves, provide no information about the people to whom they relate.