What is neonatal jaundice and how is it treated?

Neonatal or newborn jaundice is a common and usually harmless medical condition that happens in 6 out of 10 newly born babies – hence the name.

For most babies, it develops around 48 hours after birth and passes by the time the infant is about 2 weeks old.

However, for 1 in 20 newborns, careful neonatal jaundice management is needed – but why? And what treatments might be considered?

Symptoms of neonatal jaundice

The most common symptom of jaundice is yellowing of the skin but there are many other symptoms to be aware of, including:

• Yellowing on the eyes or inside the mouth
• Excessive sleepiness
• Disinterest in feeding or feeding less than normal
• Very strong yellow urine and light-coloured faeces

What causes long-lasting newborn jaundice?

Jaundice is caused by an excess of bilirubin in the blood.

Ordinarily, as red blood cells are broken down, bilirubin is produced and travels through the bloodstream to the liver. Here the bilirubin is changed into a different form and is usually passed when babies excrete faeces.

As newborn babies have a large number of red blood cells, that are constantly being broken down and replaced and their liver is not yet fully developed, bilirubin can build up.

This is why it is so common in newborns.

However, in some neonates, there are extra factors that help jaundice to develop faster or take longer to correct, including:

• Being solely breastfed
• Being born prematurely
• Having underlying health conditions – including rhesus disease, a UTI, an underactive thyroid gland, a blockage in the bile ducts or gallbladder, or Crigler-Najjar syndrome

If babies have any of these additional factors, once properly diagnosed, treatment for neonatal jaundice must begin to resolve the excess bilirubin levels.

Diagnosis of jaundice in newborns

Medical professionals will visually examine every newborn within 72 hours of birth as part of the Newborn and Infant Physical Examination (NIPE) to make sure they don’t have any abnormalities, including jaundice.

Then, if the visual examination suggests higher bilirubin levels or if medics want to formally diagnose newborn jaundice, one of the following methods will be used:

Jaundice meters or bilirubinometer

A small medical device called a bilirubinometer will be laid on the baby’s skin to see how the light inside reflects off or is absorbed by the skin.

The light is reflected by the bilirubin in the skin and the device measures the strength of the reflection, indicating the bilirubin levels in the baby’s blood.

A transcutaneous bilirubinometer or jaundice meter is preferred because:

• Results are returned in seconds
• The test is painless and much less invasive – reducing stress to both the newborn and parents
• It has a high level of accuracy
• It can be taken as many times as is needed – both to diagnose and track the progression of treatment
• By not breaking the skin, there is no risk of infection

Heel prick blood test

If a jaundice meter can’t be used, medics will take a heel prick blood test to extract a small sample of blood.

With this sample, the blood serum bilirubin level can be accurately measured – checking for jaundice.

Treating jaundice in babies

If babies are diagnosed with neonatal jaundice, there is a set treatment pathway that is normally followed.

However, it is worth noting that if bilirubin levels are too high, causing severe jaundice, doctors may recommend skipping right to exchange transfusion – but this is only in the most extreme of cases. This is because untreated jaundice can cause brain damage and become life-threatening if left to develop further.

1.      Phototherapy

Most babies will receive phototherapy treatment in the first instance.

Phototherapy, or light therapy, aims to expose your baby to as much blue light as possible, as this specific wavelength of light changes the form of the blood serum bilirubin – helping it to travel into the liver and be excreted.

It usually takes place in a cot or tunnel and can also include the use of special blue-light blankets.

The baby will be closely monitored throughout and their eyes covered to prevent discomfort or distress – with treatment usually occurring in 30-minute cycles.

2.      Intensive phototherapy

If bilirubin levels aren’t coming down quickly enough, intensive phototherapy will be recommended.

This involves increasing the amount of light or using multiple light sources – such as an overhead light and a light blanket.

3.      Exchange transfusion

If phototherapy has not been effective or if their bilirubin is just too high, babies will need a complete blood transfusion – named an exchange transfusion.

The infant’s blood is replaced with donor blood of the same type – as the donor blood will not have any bilirubin, levels should fall quickly.

4.      Other treatments

If the baby has excess bilirubin in their blood as a result of any other health problems, this specific problem will need to be treated first to help bring their bilirubin levels down.

If needed, the neonate can then begin phototherapy treatment.

Prompt neonatal jaundice management directly reduces bilirubin levels

The parents of babies diagnosed with jaundice can find this time very worrying – especially if it is combined with a premature or complicated birth.

However, here in the UK, the NHS has a stringent neonatal jaundice management system and a range of effective treatments designed to stop bilirubin levels from getting too high, preventing serious consequences from occurring.

So, while it is important to be mindful of the symptoms of jaundice in newborns, it’s not something to lose very precious sleep over!