Day 3 is a big day in any maternity ward. Mom’s milk usually comes in, her hormones are adjusting, so the day 3 blues may affect her and then…. baby turns yellow. In other words, baby becomes jaundiced.
It’s a lot for a new family to take in and adjust to. Added to this, parents are often being bombarded with all sorts of information before going home. To alleviate some of the stress, I believe that parents need to read up on this very common condition, so they are prepared if baby requires additional blood tests or treatment. This can be done well before the birth and any questions you have can be answered ahead of time.
I make reference to day 3 because there is just so much going on, but jaundice may set in anytime between day 2 and 7 and generally peaks between day 3 and 7 after birth.
What is jaundice?
The proper, medical term for jaundice is hyperbilirubinemia. That is a mouthful, I know, but the condition gets its name from the chemical called bilirubin, which causes the jaundice. This chemical causes the skin and whites of the eyes to turn yellow.
In most cases jaundice only makes baby a bit yellow but if the levels of bilirubin go too high then baby may experience a few other symptoms. We will take a look at these shortly.
Why do some babies become jaundiced?
In truth, jaundice is a very common condition which affects 60% of full-term babies and as much as 80% of babies who are born before 37 weeks of pregnancy. The good news is that only 5% of these babies will actually have bilirubin levels high enough to need treatment.
What causes jaundice?
Everyone, including you and me, have bilirubin in our blood. It is a yellow pigment which is produced when our red cells are broken down. While pregnant, mom’s liver does the work for the baby and flushes this pigment out of the system. Once baby is born, the new little liver is asked to take over this job.
Often the liver is still developing and isn’t mature enough to remove the bilirubin. The pigment builds up and baby begins to look yellow.
As the baby’s liver develops and baby is able to take bigger feeds, the bilirubin gets flushed out of the body via the digestive system.
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Which babies are most likely to develop jaundice?
As mentioned above, maturity and feeding play an important role in ridding the body of bilirubin. For this reason, babies at highest risk for developing jaundice are:
- Those born before 37 weeks of age (premature babies)
- Babies who are not getting enough breastmilk or formula. This may be due to the fact that mom’s milk is taking time to come in or the breastfeeding is difficult.
- When mom and baby have a blood incompatibility. If baby’s blood type is not compatible with mom’s then antibodies develop and destroy the red cells at a much higher rate than normal. This results in a sudden spike in the jaundice and can be dangerous. There are two types of incompatibility. These are Rh or ABO blood group incompatibility. Very often this will set in within 24 hours after birth.
- Breastfeeding jaundice. This occurs in about 10% of babies who are breastfed. There is a substance in breastmilk which blocks or slows the flushing of the bilirubin. It often begins around day 4 to 7 and can last anything from 3 to 12 weeks. Some healthcare professionals may advise moms to stop breastfeeding for 48 hours but I personally prefer not to do this. In those 48 hours, baby may get way too attached to the bottle and make breastfeeding difficult to resume. Moms in this early stage of breastfeeding have not fully established their milk so stopping the feeding may impact the production even if she does pump. Breastfeeding has such a critical place in a baby’s health and given that breastfeeding jaundice is not harmful to the baby, I would advise parents to persevere. This is, of course, only once any harmful causes of the jaundice have been ruled out.
- There are other, more rare causes of jaundice but your doctor or nurse will guide you should this become a problem for your baby.
What signs should I look out for if I suspect my baby is jaundiced?
Generally, babies are checked for jaundice before leaving the hospital. If baby looks yellow in the first 24 hours after birth then the bilirubin levels will be tested immediately. If baby shows signs of jaundice on the day of discharge, but the blood levels are acceptable, then your paediatrician or midwife will advise that a bilirubin blood test be performed the day after discharge.
Babies may be discharged early following a normal delivery or may have, in fact, been born at home. In this case parents need to be aware of the signs.
We have already mentioned that the whites of the eyes and face may appear yellow. To look for this yellowing, I would suggest you take baby into good, natural light. Certain electrical lights may make it difficult to judge the colour.
Other signs of jaundice may include:
- When you press on the baby’s forehead, nose, palms or soles of the feet, the skin looks yellow where you have pressed.
- Baby’s arms, legs and abdomen appear yellow.
- Poor feeding.
- Baby may appear excessively sleepy and is difficult to wake.
- Baby does not have at least 4 very wet nappies in a 24 hour period.
- Baby has dark coloured urine or pale poo.
- Baby is irritable or appears ill.
- Poor weight gain (this is why it is essential to do weekly weighs).
- High pitched cry.
- Backward arching of the neck and body.
What is the big deal about jaundice? Should I be worried if my child is jaundiced?
I always find this question difficult to answer because jaundice can be a simple, non-significant condition. In fact, jaundice in newborn babies is usually harmless but, as with any medical condition, if left unaddressed, can have serious consequences. I don’t like the fear factor for new parents but would rather like to stress the awareness of this condition so that dire consequences can be avoided. In the case of jaundice they certainly can be avoided if the condition is treated correctly.
With poor feeding, inadequate weight gain and so on, one can imagine that this is not good for a baby’s development. On the extreme end, untreated, high bilirubin levels can cause a condition known as acute bilirubin encephalopathy. Babies with this condition often display signs such as arching, a high pitched cry, excessive drowsiness and poor feeding.
This acute bilirubin encephalopathy needs urgent medical care to avoid permanent damage due to a condition called Kernicterus.
Kernicterus is a type of permanent brain damage. A baby with this condition may develop cerebral palsy, hearing loss, vision problems and sometimes intellectual disabilities.
How is jaundice treated?
In many cases, jaundice requires no treatment. Depending on the bilirubin levels and age of the baby, your healthcare practitioner will advise on a treatment plan.
If the levels are not too high you may be advised to increase feeds. To assist with the flushing of the bilirubin, a mother who is breastfeeding must ensure that she feeds at least 8 to 12 times a day. Formula fed babies (obviously depending on their birth weight) should receive at least 30 to 60ml of formula per feed, in the first week. Your healthcare provider can advise you on exactly how much formula your baby requires.
This treatment involves the baby being placed on a special bed under blue spectrum lights. Your baby will only wear a nappy and special protective goggles during the treatment. A fibre-optic blanket may also be placed under your baby. The treatment may just last 24 hours, but may be longer if the levels remain high.
If you live in a major centre then there are nursing sisters that can come to your home and put your baby under lights. The sister will communicate with your doctor and treatment will be stopped as soon as the bilirubin is at an acceptable level. If you do not have access to home phototherapy then your baby will need to be admitted for the treatment.
This is a type of blood protein that is given via a drip to a baby with very high bilirubin levels. It is most often necessary where there is blood incompatibility between mom and baby. This treatment makes it less likely for your baby to need an exchange transfusion.
When bilirubin levels are extremely high and your doctor is concerned about the potential of acute bilirubin encephalopathy, an exchange transfusion may be advised. It sounds really scary but in truth this can be a life-saving procedure.
The procedure involves removing a little of your baby’s blood and replacing it with donor blood or plasma to counter the effects of the bilirubin.
There is a lot to think about when having a baby. There is also a lot of information out there. Parents who are equipped with sound knowledge will navigate this journey with more ease than those thrown into the parenting role still trying to find answers.
Know that jaundice does affect a lot of babies. In most cases it doesn’t cause problems at all.
Should the bilirubin levels climb then it is critical that you react and get baby the medical attention he or she needs. Don’t be afraid to ask for help. There are many, experienced Healthcare professionals who can provide you with support and guidance.