Neonatal jaundice is when newborn babies develop a yellowing of the skin and whites of the eyes. It is a harmless condition and fairly common, affecting around 6 out of 10 babies. Oxygen is carried by red blood cells in the body, and when these red blood cells break down they create bilirubin. Bilirubin is then cleared from the body by the liver. However, neonatal jaundice occurs when there is excess bilirubin in the blood. A newborn baby’s liver is still developing and has not perfected the art of removing bilirubin from the blood by the time they are born. For this reason, it occurs more commonly in babies born prematurely. You may notice jaundice on their skin, although in darker skin babies this might be harder to pick up. Yellowing can also be seen in the whites of the eyes, on the palms and soles, and in the mouth. The poo may be very pale and the pee may be very dark. Your baby may also be sleepy and not feed very well. The symptoms tend to develop 2 to 3 days after birth and get better after a few weeks on their own, once the liver is more developed. Some cases may require treatment if the bilirubin level is very high.
Neonatal jaundice is common as newborn babies' livers are not completely developed. Rarely it may be due to other medical conditions, such as an underactive thyroid gland, an infection of the urine system, a blockage in the liver and gallbladder, inherited conditions, or when the mother and baby have different blood groups that are not compatible.
After birth, your baby will have a newborn physical examination, and the doctor or midwife will check for signs of jaundice. If they notice any yellowing, your baby will have a simple blood test. It’s important that this is monitored in the first 24 hours, especially if your baby was born early. If you notice it later, it is important to seek help from your health visitor or your GP. If you notice the yellowing of their skin or the whites of their eyes is worsening or baby is becoming difficult to feed or drowsy, it is important to contact your supporting health team straight away.
At very high doses, bilirubin can pass out of a baby’s bloodstream and into their brain, causing permanent brain damage. This is called kernicterus. Thankfully this is a very rare condition due to the effective management that happens after a baby’s birth.
As the liver continues to develop over a few weeks, most cases will get better on their own, without any treatment. A blood test will determine the level, and a health visitor or hospital doctor can look this up on a chart to guide whether treatment is necessary. If treatment is required, there are two main ways to bring the bilirubin levels down to a safe level: 1) Phototherapy – a light is shone onto baby’s skin that changes the form of bilirubin into something that can be broken down by the liver more easily 2) Exchange transfusion – baby’s blood is removed from their body and replaced with a matching donors blood. This donor blood has normal levels of bilirubin