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Jaundice of the newborn

Jaundice of the newborn

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Jaundice is a very common and often harmless condition in newborns that causes the yellowing of the skin and whites of the eyes. Other symptoms of jaundice can include:

  • Darkened urine (should be straw coloured/clear)
  • Pale-coloured bowel motions (should be yellow/brown)

When does jaundice start to appear?

Jaundice usually appears within 2-3 days following birth and if mild, resolves spontaneously over the first 2 weeks of life.  More severe cases of Jaundice require treatment.

What causes jaundice?

Jaundice is caused by elevated blood bilirubin levels. Bilirubin is a yellow-pigmented substance that is produced when red blood cells (RBC’s) are broken down. Throughout everyday life, the human body is constantly making and breaking down cells. These broken-down RBCs are then processed through the liver for elimination from the body.

Newborn babies often need time to adapt to extra-uterine life - and with an immature liver, the processing of RBC’s can be slowed. This leads to increased bilirubin levels, “Jaundice.”

Which babies have an increased risk for jaundice?

  • Premature babies

  • Liver disease

  • Babies with an infection

  • ABO incompatibility (baby has a blood type which conflicts with mother’s blood type)

  • Breastfed babies (mild jaundice which can last up to 4 weeks, not requiring treatment, little known as to why this happens)

If left untreated, severe jaundice can cause a serious condition known as kernicterus – permanent brain damage. So regular screening/symptom monitoring in the first week can be critical.

What are the treatment options for jaundice?

  1. Phototherapy – your baby needs (an artificial) sun tan! Controlled UV light therapy, which is minimally invasive and helps process unconjugated bilirubin from the body.

  2. Blood transfusion (rare!) – for cases of extreme/severe jaundice, your baby will need to have some of their blood volume replaced by donor blood.

Written by Keryn Thompson, RM & IBCLC (L-301766)

References:

Bratlid, D., Nakstad, B. and Hansen, T., 2011. National guidelines for treatment of jaundice in the newborn. Acta Paediatrica, 100(4), pp.499-505.

Cohen, R., Wong, R. and Stevenson, D., 2010. Understanding Neonatal Jaundice: A Perspective on Causation. Pediatrics & Neonatology, 51(3), pp.143-148.

de Almeida, M. and Draque, C., 2007. Neonatal Jaundice and Breastfeeding. NeoReviews, 8(7), pp.e282-e288.

Gourley, G., 2002. Breast-feeding, neonatal jaundice and kernicterus. Seminars in Neonatology, 7(2), pp.135-141.

Gundur, N., Kumar, P., Sundaram, V., Thapa, B. and Narang, A., 2010. Natural history and predictive risk factors of prolonged unconjugated jaundice in the newborn. Pediatrics International, 52(5), pp.769-772.

McDonagh, A. and Maisels, J., 2008. Phototherapy of Neonatal Jaundice. The New England Journal of Medicine, 358(8), pp.915-920.

McGillivray, A. and Evans, N., 2011. Severe neonatal jaundice: Is it a rare event in Australia?. Journal of Paediatrics and Child Health, 48(9), pp.801-807.

Mitra, S. and Rennie, J., 2017. Neonatal jaundice: aetiology, diagnosis and treatment. British Journal of Hospital Medicine, 78(12), pp.699-704.

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