What is jaundice?
Jaundice is the name given to the yellow appearance of the skin and the whites of the eyes. Jaundice is NOT a liver disease.

Is jaundice common in new born babies?
Yes. Jaundice is very common in newborn babies. About 90% of newborn babies will become jaundiced two or three days after birth. Jaundice reaches its peak at about four days of life and then gradually disappears in most babies by the time they are two weeks old. Jaundice does not necessarily mean your baby is ill.

Jaundice can occur within the first twenty-four hours after birth, but this is rare. If this happens it is important that a neonatologist or paediatrician (doctors who specialise in the care of babies and children) sees your baby. Normally this will not be a problem as you will still be in hospital. If your baby is at home it is important you tell your midwife or doctor.

Should jaundice go away?
Jaundice caused by a build-up of bilirubin, as described above, normally disappears by the time your baby is ten to fourteen days old. This may take a bit longer if the baby is premature, in which case it can take about three weeks to go away.

Can the level of jaundice be measured?
Yes. The level of bilirubin in your baby’s blood can be measured quite simply. A heel prick blood sample can be taken. This is sometimes called an “SB” or a “bili” test. This will measure the serum bilirubin level and show whether the jaundice level is getting high or even, in some cases, whether your baby has jaundice. This is not as silly as it sounds as it can be difficult to see jaundice in some babies. Sometimes a small light meter
may be used to measure the jaundice level.

What causes baby jaundice?
When your baby is in the womb the waste products are removed through the placenta. Once your baby is born their own body has to do this. It can take some time for a baby to be able to remove their waste products properly. Therefore, in the early days of your baby’s life some waste products may build up
in their body. One waste product is called bilirubin. If there is too much bilirubin your baby will be jaundiced.

What is bilirubin?
The body continuously makes new red blood cells and breaks down old ones. Bilirubin is made when the old red blood cells are broken down.

Why do babies become jaundiced?
In an adult the red blood cells last about 120 days but in a newborn baby they last for a shorter time. Newborn babies have a higher than normal number of red blood cells. Because your baby has more red blood cells which are being broken down more quickly there is more bilirubin being made. Your baby’s liver removes the bilirubin from their blood. But the liver is a complicated organ and, despite a baby being full term, can take a few days to work properly. So, in the first few days of life bilirubin builds up in the blood and causes nine out of ten babies to be jaundiced.

Is there any treatment for jaundice?
Most babies will need no treatment at all and the jaundice will disappear by the time the baby is two weeks old. However, a small number of babies do need some treatment, depending on how much bilirubin there is in the blood. Your midwife or doctor will know from experience when this is necessary.
If the jaundice level gets too high there can be a concern that it could cause damage to your baby’s brain so the normal treatment is phototherapy to reduce the bilirubin level. Your baby will be placed naked, except for some eye pads, in a cot under a special blue light. Alternatively, your baby may be wrapped in a bili-blanket. The light breaks down the bilirubin. You will be encouraged to feed your baby so that your baby produces
plenty of urine. Phototherapy can usually be stopped within a few days.

In mild cases your midwife may suggest that you place your baby in the sunlight, by a window, for example. Do be careful that your baby does not overheat or become sunburned.

Will baby jaundice harm my baby?
Baby jaundice is not usually dangerous. If there is any doubt, a blood sample will be taken to measure the bilirubin to make certain there is no risk to your baby. Phototherapy is always started well before any dangerous level is reached.

Why do some babies remain jaundiced?
Baby jaundice normally clears by the time your baby is two weeks old. However, sometimes it lasts longer. There can be a number of reasons why jaundice continues:
- Your baby may have been born early. In premature babies jaundice may take three weeks to clear.
- Your baby may have a condition in which the blood cells break down more quickly than is normal for babies. This is often recognised very soon after the baby is born, or even during pregnancy, and further treatment may be necessary.
Your baby will be seen by a blood specialist called a paediatric haematologist.
- Jaundice may continue occasionally in babies who are entirely well and are being breast fed. Breast feeding may safely continue and the jaundice will fade with time. There is more information on breast feeding jaundice later in this leaflet.
- Your baby may have an infection or other illness.
- Your baby may have a thyroid gland that is not working properly. This is usually tested as part of a blood test which is carried out on all babies between 5 and 8 days old, called the Guthrie Test.
- Your baby may have a problem with their liver. This is rare.

Is there anything else I can do?
Yes, you should check the colour of your baby’s stools (poo) and urine:
- The urine of a newly born baby should be colourless. If your baby’s urine is persistently yellow then this can indicate liver disease and you should tell your doctor, midwife or health visitor, whether or not there is jaundice too.
- The stools of a breast fed baby should be green / daffodil yellow.
- The stools of a bottle fed baby should be green / English mustard yellow.
Check your baby’s stool colour against the stool colour chart below. If the colour of the stools is the same as in B then you should tell your doctor, midwife or health visitor, whether or not there is jaundice too.

Always tell your doctor, midwife or health visitor if your baby’s stool colour is the same as in B no matter the age of your baby.

Why is the stool and urine colour important?
Normal baby jaundice is caused by a build-up of unconjugated bilirubin. When red blood cells are broken down
unconjugated bilirubin is made. The liver processes the unconjugated bilirubin by adding a “sugar” which changes the bilirubin to conjugated bilirubin.

Babies with liver disease can also have jaundice. This jaundice, however, is caused by a build-up of conjugated bilirubin. The conjugated bilirubin is picked up by the blood and is passed around the body causing jaundice. It also causes the urine to be yellow as the kidneys try to get rid of the conjugated bilirubin, which is water soluble. Yellow urine in a baby is not normal and the baby should be investigated for liver disease. That’s why it’s important to check the urine colour.

The stool colour may also give an indication of liver disease. If there is a blockage or inflammation in the liver or the biliary drainage system it may prevent the bile from draining from the liver. This will mean that the stool will not be as coloured as normal and appear pale or even the colour of putty. Any baby, at
whatever age, with pale stools or stools which appear “fatty” in texture should be investigated for liver disease. That’s why it’s important to check the stool colour. In some cases there can be an intermittent obstruction and the stools can be alternately paler and darker.

What should be done if my baby’s jaundice does not go?
The golden rules are:
•If jaundice continues beyond 14 days of age in a full-term baby or 21 days in a premature baby then this should be investigated.
•If your baby’s stools and urine are not the right colour then this should be investigated at whatever age — you don’t need to wait until the baby is two or three weeks old.

A split bilirubin blood test should be carried out. This test may need to be done at your local hospital.
This blood test measures the ratios of the conjugated and unconjugated bilirubin levels in your baby’s blood. If the conjugated fraction is greater than 20% of the total bilirubin your baby should be referred to a specialist unit as this indicates that the cause is a liver disease.

Just to be clear — a serum bilirubin test (sometimes called SB or bili test) measures the total amount of the bilirubin and will show the level of jaundice but does not show whether the cause is liver disease or not. This is the point of having a split bilirubin test.

Note: A baby can have normal baby jaundice and jaundice caused by liver disease at the same time.

I’ve been told my baby is feeding well, growing and looks well so the jaundice can’t be caused by liver disease. Is this true?
Sadly no, it’s a common mistake that people make. In the early stages of liver disease a baby can look and seem entirely well and can be feeding exceptionally well. The best way to make sure is to look at the stools and urine and have a split bilirubin test.

I’ve been told my baby has breast milk jaundice. What does this mean?
Some babies who are breast fed may have jaundice which continues. In this case the blood levels will be normal except for a raised total bilirubin. The stools and urine colour will be normal too. Breast milk jaundice is harmless and will gradually disappear. In a small number of cases it can take a few months to totally disappear.

Quite frequently parents are reassured that the cause of prolonged jaundice is breast milk jaundice without testing. The vast majority of babies will have breast milk jaundice but a very few will have liver disease jaundice — or even both. However, it is important that a diagnosis of breast milk jaundice is made
after a split bilirubin test is done.

Hopefully this Jaundice information could help you more understand about Jaundice.

Thanks to Children’s Liver Disease Foundation for this great information.

Children’s Liver Disease Foundation
36 Great Charles Street
Birmingham
B3 3JY
Tel: 0121 212 3839
Fax: 0121 212 4300
email: info@childliverdisease.org
www.childliverdisease.org