Neonatal jaundice - Queensland Centre for Mothers & Babies

Queensland Maternity and Neonatal Clinical Guidelines Program
Version 4.1 last updated: 06/02/2013
Neonatal jaundice
Parent information sheet
This information sheet will answer commonly asked questions about
neonatal jaundice.
IMPORTANT: The information contained in this information sheet is general
information only. It is not intended to be treated by you as professional advice for a
particular factual situation and is no substitute for seeking professional advice from
your health care provider. In all procedures your health care provider will explain what
will happen, the risks and benefits and will ask for your informed consent. If you choose
not to have an intervention your decision will be respected.
What is neonatal jaundice?
Neonatal jaundice refers to a yellow
colouring of a baby’s skin and or
eyes.
Unusually sleepy
Diffi culty feeding
Yellow
colouring is
usually fi rst
seen in the
eyes and face.
If the jaundice
worsens,
the yellow
colouring may
spread down
the body and
out to the
baby’s hands
and feet.
A baby showing signs of neonatal jaundice
What causes neonatal jaundice?
The yellowing is caused by a
buildup of bilirubin in the baby’s
body. Bilirubin is produced when old
red blood cells are broken down.
Every newborn has excess bilirubin
but most babies can remove this
through bowel movements in a few
days after birth.
What is breast milk jaundice?
Breast milk jaundice is a harmless
type of neonatal jaundice that
develops 5 to 7 days after birth and
peaks when your baby is around
14 days old. If your baby has
breast milk jaundice and they are
having regular bowel movements,
passing clear urine regularly and are
otherwise well there is no need to
stop breastfeeding.
Who is more likely to get
neonatal jaundice?
Your baby is more likely to get
neonatal jaundice if he or she:
›is › born prematurely (before 37
weeks pregnancy)
››
is slow to start breastfeeding and
has low milk intake
››
has bruising or an infection
››
has a brother or sister who had
neonatal jaundice
››
has a different blood type from
his or her mother or has difficulty
processing chemicals in their body
(e.g. babies with thyroid conditions)
Is neonatal jaundice harmful to
my baby?
Mild jaundice, with low levels of
bilirubin, is common and is not
usually harmful to your baby.
In severe cases or if left untreated,
the increased levels of bilirubin may
affect the brain and cause:
››
seizures and muscle spasms (e.g.
back arching)
›cerebral › palsy
››
delays in development
How do I know if my baby has
neonatal jaundice?
Health care providers monitor
all babies for neonatal jaundice.
Neonatal jaundice is usually first
detected by looking at the colour of
your baby’s skin.
Mild forms of neonatal jaundice can
be seen in yellowing on the baby’s
head. More severe forms can be
seen in yellowing on the rest of the
body.
Two tests can be done to properly
diagnose neonatal jaundice. These
tests are called the transcutaneous
bilirubin test (TcB) and the serum
bilirubin test (SBR).
What is the transcutaneous
bilirubin test?
The TcB is performed with a
small hand-held instrument. This
instrument is pressed against
your baby’s head or chest. The
instrument produces a light that
passes through your baby’s skin. A
number is then displayed showing
the level of bilirubin in the skin.
If your baby has a high reading, you
may be offered a serum bilirubin
test (SBR).
A baby having a TcB done
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What is the SBR?
The SBR involves testing a sample
of your baby’s blood. Blood for
this test is usually taken by a
needle prick on your baby’s heel.
Depending on the level of bilirubin in
your baby’s blood, your health care
provider may offer treatment for
your baby’s jaundice.
What is the treatment for
neonatal jaundice?
Mild jaundice often goes away
without treatment, however babies
with high levels of bilirubin or severe
jaundice may need treatment.
Treatment depends on the level of
bilirubin in your baby’s body and the
cause of the jaundice. Treatments
include phototherapy, exchange
transfusion (only in severe cases) or
medication.
What will happen if my baby has
phototherapy?
Phototherapy is treatment with
artificial lights that are usually blue
but sometimes white. The light
helps the baby’s body to break
down the bilirubin so that it can
be easily removed through bowel
movements. Phototherapy is given
either in the form of overhead light,
a biliblanket or a bilisoft. While your
baby is are having treatment, your
health care provider will monitor any
changes in your baby’s skin colour,
temperature, bowel movements,
urine output and bilirubin in his or
her blood.
What are the possible side
effects of phototherapy?
Some of the possible side-effects of
having phototherapy are:
››
Diarrhorea
››
Significant loss of water from the
body via sweat, water in bowel
movements, urine or breath
››
Bronze baby syndrome (condition
where skin turns a bronze colour
due to a buildup of iron in the body)
What will happen if my baby has
overhead phototherapy?
Overhead phototherapy is normally
done in a special care nursery
or a paediatric ward within a
hospital. Your baby may need to be
transferred to a larger hospital for
treatment. Your baby will wear only
a nappy while under the lights so
that the maximum amount of skin is
exposed to the light. Your baby will
also wear an eye mask to protect
his or her eyes from the artificial
lights.
A baby having overhead phototherapy
What will happen if my baby has
treatment with a biliblanket or
bilisoft?
A biliblanket is a stiff pad and a
bilisoft is a soft pad, both have
phototherapy lights in them. Your
baby will be placed on or wrapped
in the pad. The pad is attached by a
cord to an electricity socket.
Some hospitals may arrange to
have this treatment done at home
while other hospitals will do this
treatment only in the hospital.
Your baby can usually stay on or
wrapped in the pad when feeding.
Am I able to feed my baby
during phototherapy?
If your baby is receiving overhead
phototherapy, this will be switched
off during feeds. Your baby’s eye
mask will also be removed so
that you and your baby can see
each other. The time spent out of
overhead phototherapy should be
monitored and kept to a minimum.
Why are regular feeds important
for babies with jaundice?
It is important that babies who have
jaundice are fed regularily, either
demand feeding (feeding the baby
as he or she shows signs of hunger)
or at least every 3-4 hours. Regular
feeds help the baby’s body digest
and get rid of the bilirubin more
quickly. Your health care provider
will help you make sure your baby
is getting enough fluid. They may
suggest feeding your baby more
often.
When should I contact my
health care provider?
You should contact your health care
provider if you notice your baby has:
››
yellowing of the skin
››
jaundice that re-appears after initial
treatment (usually called rebound
jaundice)
››
skin yellowing that is spreading
further over their body
››
jaundice that is still there 14 days
after birth
››
pale-coloured bowel motions
››
dark yellow urine or lack of urine
››
trouble feeding or is unwell
Will my baby receive follow up?
If your baby has had jaundice or
has been treated for jaundice, you
should arrange to have a follow up
visit with your health care provider
within 1-3 days after your baby has
been discharged from hospital.
At the follow-up visit your baby’s
jaundice will be assessed along
with their weight, feeding, urine and
bowel movements. If your baby is
showing signs of jaundice they may
need further treatment in hospital.
If you have comments about the
content of this parent information sheet
please email info@qcmb.org.au
Warning: Babies who have been wrapped in clothing stored with moth balls containing napthalene can
develop severe jaundice and, in rare cases, brain damage. Parents should wash items that have been
exposed to mothballs containing napthalene before use.
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