Newborn with Jaundice
Types, Signs & Treatment
Jaundice is a common condition that affects many newborns in their early days of life.
As lactation consultants, jaundice is a condition we treat regularly at Full Circle. To give you a better understanding, we’ll explore the types of jaundice in newborns, signs to watch out for, treatment options and the impact of jaundice on breastfeeding.
What causes jaundice?
Jaundice in newborns occurs due to the buildup of bilirubin, a yellow pigment produced when red blood cells break down. Bilirubin is typically processed by the liver and excreted from the body through bile, which is then eliminated in the stool.
However, in newborns, the liver's ability to process bilirubin may be immature or overwhelmed, leading to an accumulation of bilirubin in the bloodstream and subsequent jaundice.
Types of Jaundice in Newborns
Physiological Jaundice
This is the most common type of jaundice in newborns, affecting up to 60% of full-term babies and 80% of premature infants. It typically appears within 2-3 days after birth and resolves on its own within a couple of weeks.
Breast Milk Factors
Breastfeeding jaundice and breast milk jaundice are related to breastfeeding practices and substances in breast milk.
Breastfeeding jaundice may occur when the baby is not getting enough breast milk, leading to dehydration and reduced bilirubin elimination.
Breast milk jaundice, on the other hand, is caused by certain substances in breast milk that can interfere with bilirubin metabolism.
Blood Group Incompatibility
In some cases, jaundice in newborns can be caused by blood group incompatibility between the baby and the mother. This occurs when the baby has a different blood type than the mother, leading to the production of antibodies that can break down the baby's red blood cells and release excess bilirubin.
Prematurity
Premature infants are more prone to developing jaundice due to the immaturity of their liver and the increased breakdown of red blood cells.
Infection or Illness
In rare cases, jaundice in newborns can be a sign of an underlying infection or illness that affects the liver's ability to process bilirubin.
It's important to note that the specific cause of jaundice in a newborn may vary, and a healthcare professional should always evaluate each case to determine the underlying factors contributing to the condition.
Incidence of Jaundice
Approximately 60% of full-term newborns and 80% of premature infants develop jaundice within the first week of life.
Physiological jaundice, which is the most common type of jaundice in newborns, affects about 50-60% of full-term babies and a higher percentage of premature infants.
Breastfeeding jaundice, often related to inadequate milk intake, affects around 10-20% of breastfed newborns.
Breast milk jaundice, caused by certain substances in breast milk, occurs in approximately 1-2% of breastfed infants and can persist for several weeks.
Jaundice resulting from blood group incompatibility occurs in about 0.5-1.5% of newborns, with varying degrees of severity.
Signs of Jaundice
Identifying jaundice in a newborn is crucial for timely intervention. Here are some signs to look out for:
Yellowing of the skin and eyes: Jaundice often starts on the face and progresses downward. If you notice a yellowish tint in your baby's skin or the whites of their eyes, it may be a sign of jaundice.
Changes in stool and urine: Babies with jaundice may have pale stools instead of the usual yellowish colour. Additionally, their urine might appear dark yellow or amber.
Lethargy and poor feeding: Jaundiced newborns may exhibit decreased energy levels, sleepiness, and reduced interest in feeding.
Treatment for a Jaundice Baby
The treatment for jaundice in newborns often depends on the severity and underlying cause. While mild cases of jaundice may not require intervention other than close monitoring, here are additional treatment options that can be considered:
Phototherapy
Phototherapy is a common treatment for jaundice in newborns. It involves exposing the baby's skin to special blue or white lights that help break down bilirubin into a form that can be easily eliminated from the body.
The light alters the bilirubin molecules, making them more water-soluble and allowing them to be excreted through the urine and stool. Phototherapy can be administered using different devices, such as biliblankets (a pad with built-in lights) or phototherapy beds.
Exchange Transfusion
In severe cases of jaundice that do not respond to phototherapy or when the bilirubin levels pose a significant risk, an exchange transfusion may be necessary.
This procedure involves removing a small amount of the baby's blood and replacing it with compatible donor blood. Exchange transfusion helps rapidly reduce the bilirubin levels and prevent complications associated with severe jaundice.
Breastfeeding
Breastfeeding is generally encouraged and important for babies with jaundice. Frequent and effective breastfeeding helps stimulate the baby's digestion and elimination processes, promoting the elimination of bilirubin.
Adequate hydration and nutrition from breast milk can also support the overall health of the baby. However, if the baby has severe jaundice or is not feeding well, healthcare professionals may recommend additional measures.
Sunlight Exposure
Filtered sunlight exposure, also known as sunlight phototherapy, can be used as an adjunct to conventional phototherapy. Under healthcare professional guidance, the baby's skin is exposed to filtered sunlight for a short duration.
The sunlight helps convert the bilirubin in the skin into a form that can be eliminated. It's important to note that direct sunlight exposure without appropriate filtering can lead to sunburn and overheating, so it should be avoided.
It's crucial to consult with healthcare professionals for an accurate diagnosis and appropriate treatment plan for jaundice in newborns. They can provide personalised guidance based on the severity of jaundice, underlying causes, and the baby's overall health.
Jaundice Breastfeeding
Breastfeeding is a beautiful and essential way to nourish your newborn, providing numerous benefits for both you and your baby. However, when your little one is diagnosed with jaundice, you might find yourself facing unique challenges and concerns.
Understanding how jaundice impacts breastfeeding can help alleviate some of your worries and provide guidance on navigating this situation. Here, we will explore the effects of jaundice on breastfeeding and offer practical tips for parents struggling to breastfeed a jaundice baby.
Jaundice and Breastfeeding Challenges
Jaundice is a common condition in newborns, characterised by a yellowing of the skin and eyes due to elevated bilirubin levels. While jaundice itself does not typically affect a baby's ability to breastfeed, some factors associated with jaundice can pose challenges:
Lethargy: Jaundiced babies may exhibit lethargy and decreased energy levels, making it more challenging for them to actively engage in breastfeeding.
Poor Sucking Reflex: In some cases, jaundiced newborns may have a weaker sucking reflex, leading to difficulties in latching onto the breast and effectively extracting milk.
Sleepiness: Jaundice can make babies sleepier than usual, which may result in decreased feeding frequency and shorter feeding sessions.
It's important to remember that breastfeeding remains important for your baby's overall health, even if they have jaundice.
Here are some tips to support breastfeeding during this challenging time:
Frequent Feedings: Ensure you feed your baby at least 8-12 times a day, or as per your healthcare professional's guidance. Frequent feeding stimulates milk production, helps prevent dehydration, and promotes the elimination of bilirubin through bowel movements.
Wakefulness Techniques: If your baby is sleepy or less interested in feeding, try gentle techniques to awaken them before nursing. You can stroke their feet, undress them (have a skin-to-skin breastfeed), or use a cool washcloth to gently stimulate their senses.
Proper Latching: Ensure your baby is latching correctly to optimize milk transfer. Seek guidance from a lactation consultant or breastfeeding specialist who can help you achieve a deep and effective latch.
Breast Compression: During feeding, gently compress your breast to encourage a continuous flow of milk. This can help ensure your baby receives enough hindmilk, which is higher in fat and aids in weight gain.
Seek Professional Support
If you're struggling with breastfeeding a jaundiced baby, don't hesitate to seek professional support. Lactation consultants, pediatricians, or breastfeeding specialists can provide individualised guidance and support to address your specific challenges.
They can assess your baby's latch, offer feeding techniques, and monitor your baby's weight gain and bilirubin levels to ensure they're on the right track.
Monitor Hydration and Elimination
Keep an eye on your baby's hydration and elimination patterns, as these are important indicators of their well-being. Ensure your baby has an adequate number of wet diapers (at least 6-8 per day) and that their urine is pale in colour.
Additionally, monitor their stool frequency and consistency, as changes in stool can be related to breastfeeding and jaundice.
Teamwork and Self-Care
Remember, navigating breastfeeding challenges and jaundice can be emotionally and physically draining. Lean on your support system for assistance and take care of yourself. Stay hydrated, eat a balanced diet, and rest whenever possible. Seek emotional support from loved ones or join support groups where you can connect with other parents going through similar experiences.
If you’re concerned that your newborn is jaundiced and needs support, please contact your GP or paediatrician. However, if you’re looking for lactation support for your jaundice baby, we’re here to help. Please reach out to us and book a consult with our experienced lactation consultants today.
Newborn Jaundice FAQs
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Jaundice in newborns is generally a common and benign condition. In most cases, it resolves on its own without causing any long-term health problems. However, the severity of jaundice can vary, and in some instances, it may require medical attention. Here's an overview of the varying severity of jaundice in newborns:
Physiological Jaundice: Physiological jaundice, which is the most common type, occurs due to the normal breakdown of red blood cells and the immaturity of the baby's liver in processing bilirubin. It typically appears on the second or third day after birth and gradually resolves within a week or two without causing harm. This type of jaundice is usually mild and does not require extensive medical intervention.
Pathological Jaundice: Pathological jaundice refers to jaundice that occurs due to an underlying medical condition. It may occur earlier, be more severe, or persist for a longer duration than physiological jaundice. Pathological jaundice can be caused by factors such as blood group incompatibility, infection, liver dysfunction, or metabolic disorders. Prompt medical evaluation and appropriate treatment are crucial to manage pathological jaundice effectively.
Severe Jaundice: In some cases, jaundice can reach high levels, resulting in severe hyperbilirubinemia. High bilirubin levels can potentially lead to a condition called kernicterus, which is a rare but serious neurological complication. Kernicterus can cause long-term neurological damage, including hearing loss, developmental delays, and movement disorders. However, severe jaundice leading to kernicterus is rare, especially with proper monitoring and timely intervention.
It's important for healthcare providers to assess the severity of jaundice, considering factors such as the bilirubin level, the baby's age, and any associated risk factors. They can determine the appropriate course of action, such as additional monitoring, phototherapy, or, in rare cases, exchange transfusion to lower bilirubin levels and prevent complications.
If you have concerns about your baby's jaundice, it is recommended to seek guidance from your healthcare provider. They can assess your baby's condition, provide appropriate management, and offer necessary support and reassurance throughout the process.
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Newborn babies get jaundice due to the accumulation of bilirubin in their bodies. Bilirubin is a yellow pigment that is produced when red blood cells naturally break down. In a healthy individual, the liver processes bilirubin and excretes it from the body through bile, which is then eliminated in the stool. However, in newborns, jaundice can occur due to the following reasons:
Physiological Factors: Physiological jaundice is the most common type of jaundice in newborns. It occurs as a normal response to the increased breakdown of red blood cells that happens after birth. Newborns have a higher number of red blood cells at birth, and their livers may take a few days to mature and effectively process the bilirubin. As a result, bilirubin can build up in the baby's bloodstream, leading to jaundice.
Immature Liver Function: The liver plays a crucial role in processing and eliminating bilirubin. In newborns, the liver is still developing and may not function at full capacity, especially in the first few days of life. This immaturity can contribute to reduced bilirubin clearance, increasing the likelihood of jaundice.
Breast Milk Factors: Breast milk jaundice and breastfeeding jaundice are two types of jaundice associated with breastfeeding. Breastfeeding jaundice may occur when the baby is not getting enough breast milk, leading to dehydration and reduced bilirubin elimination. Breast milk jaundice, on the other hand, is caused by certain substances in breast milk that can interfere with bilirubin metabolism, leading to elevated levels of bilirubin in the baby's blood.
Blood Group Incompatibility: In some cases, jaundice in newborns can occur due to blood group incompatibility between the baby and the mother. If the baby has a different blood type than the mother, the mother's immune system may produce antibodies that attack the baby's red blood cells, leading to an increased breakdown of red blood cells and subsequent jaundice.
Other Factors: Certain medical conditions, such as infections, liver disease, or genetic disorders, can also cause jaundice in newborns. These cases are relatively rare but may require specific medical interventions and treatments.
It's important to note that while jaundice is common in newborns, proper evaluation and monitoring by healthcare professionals are necessary to determine the underlying cause and ensure appropriate management, especially in cases of prolonged or severe jaundice.
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Clearing your baby's jaundice typically involves ensuring adequate hydration, promoting bilirubin elimination, and monitoring their progress. While mild cases of jaundice often resolve on their own, it's essential to consult with a healthcare professional for proper guidance and support.
Here are some general strategies to help clear your baby's jaundice:
Increase Feeding Frequency: Ensure that your baby is feeding frequently, ideally at least 8-12 times a day. Breastfeeding or formula feeding helps stimulate the baby's digestive system and promotes the elimination of bilirubin through bowel movements.
Monitor Hydration: Adequate hydration is important to support bilirubin elimination. Check your baby's urine output and aim for at least six to eight wet nappies per day. The urine should be pale in color, indicating proper hydration.
Encourage Effective Feeding: Ensure your baby is latching properly and effectively emptying the breasts during breastfeeding. Seek support from a lactation consultant or breastfeeding specialist if needed. If you're formula feeding, follow the recommended guidelines for preparing and offering formula.
Consider Phototherapy: Phototherapy is a common treatment for jaundice. Exposing your baby's skin to special lights helps break down bilirubin, making it easier for the body to eliminate. Phototherapy can be administered in a hospital setting or at home using portable devices. Consult your healthcare provider to determine if phototherapy is necessary and the best approach for your baby.
Sunlight Exposure: Under medical guidance, limited sunlight exposure can be beneficial. Exposing your baby's skin to indirect sunlight can aid in the breakdown of bilirubin. However, it's crucial to follow your healthcare provider's recommendations regarding duration, timing, and protection from excessive sunlight.
Follow Medical Advice: Follow the recommendations provided by your healthcare provider, including scheduled check-ups and blood tests to monitor your baby's bilirubin levels and overall progress. They may also suggest additional treatments or interventions based on the severity of jaundice.
Remember, each baby is unique, and the appropriate management approach may vary. It's important to consult with a healthcare professional who can assess your baby's specific situation, provide individualized advice, and monitor their progress to ensure their jaundice clears effectively and safely.
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If a baby has jaundice, it means there is an accumulation of bilirubin, a yellow pigment, in their body. Bilirubin is a byproduct of the normal breakdown of red blood cells. While mild jaundice is common and usually resolves on its own, more severe or prolonged cases may require medical attention.
Visible Yellowing of Skin and Eyes: The primary visible sign of jaundice is the yellowing of the baby's skin and eyes. This yellow discoloration, called icterus, occurs due to the buildup of bilirubin in the bloodstream. It typically starts on the face and then spreads to the rest of the body.
Physiological Jaundice: Physiological jaundice is the most common type of jaundice in newborns and is considered a normal response to the breakdown of red blood cells. It typically appears around the second or third day of life, peaks within a few days, and then gradually resolves without treatment.
Potential Complications: In most cases, jaundice in newborns is benign and resolves without complications. However, in some instances, elevated levels of bilirubin can pose risks:
Severe Jaundice: If the levels of bilirubin become too high, it can lead to severe jaundice, also known as hyperbilirubinemia. This can increase the risk of complications such as kernicterus.
Kernicterus: Kernicterus is a rare but serious condition that occurs when high levels of bilirubin cross the blood-brain barrier and cause damage to the brain. It can result in long-term neurological problems, including hearing loss, intellectual disabilities, movement disorders, and developmental delays. However, with proper monitoring and timely intervention, kernicterus can be prevented.
References
Bhutani, V. K., Johnson, L., & Sivieri, E. M. (2006). Predictive ability of a predischarge hour-specific serum bilirubin for subsequent significant hyperbilirubinemia in healthy term and near-term newborns. Pediatrics, 118(3), 1-9. doi: 10.1542/peds.2006-0301
American Academy of Pediatrics Subcommittee on Hyperbilirubinemia. (2004). Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation. Pediatrics, 114(1), 297-316. doi: 10.1542/peds.114.1.297
Maisels, M. J., Bhutani, V. K., & Bogen, D. (2020). Hyperbilirubinemia in the newborn infant ≥35 weeks' gestation: An update with clarifications. Pediatrics, 146(1), e2020-1649. doi: 10.1542/peds.2020-1649
Gartner, L. M., Morton, J., Lawrence, R. A., Naylor, A. J., O'Hare, D., & Schanler, R. J. (2005). Breastfeeding and the use of human milk. Pediatrics, 115(2), 496-506. doi: 10.1542/peds.2004-2491
World Health Organization. (2003). Exclusive breastfeeding for six months best for babies everywhere. Retrieved from https://www.who.int/mediacentre/news/statements/2003/bst01/en/
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