A nurse is assisting with monitoring a newborn who is 3 days old and has received phototherapy

Table of Contents Show

What causes jaundice?
Signs and symptoms
How is jaundice diagnosed?
Will my baby need treatment?
How does phototherapy work?
Types of phototherapy
What will happen while my baby is having phototherapy?
What will happen if the phototherapy doesn’t work?
Side effects of phototherapy
Does jaundice cause any long-term problems?
Seek medical advice if:
References:
Symptoms of jaundice in babies
Physiological jaundice

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Jaundice is a yellowing of the skin, and sometimes the whites of the eyes or the gums. If your baby has dark skin, the main sign may be a yellowing in the whites of their eyes or the gums. Mild jaundice is quiet common in newborn babies and is usually a temporary condition that causes no problems. However, severe cases of jaundice can be harmful, so if you think your baby has jaundice, it is always best to let your doctor know.

What causes jaundice?

Jaundice is caused by an accumulation of yellow substance called bilirubin in the blood. Bilirubin is a normal part of the waste produced when used red blood cells are broken down, and is normally passed out of the body in urine and faeces (poo).

Newborn babies produce and break down a large amount of red blood cells very quickly and while their young livers are fully maturing in the first days of life, they may not function efficiently and bilirubin may accumulate in the blood. Usually, as soon as the liver matures and functions more effectively, the jaundice will go away. There are other rare causes of jaundice which your doctor will discuss with you.

Signs and symptoms

The yellow colour of the skin is the main symptom of jaundice usually beginning on the baby’s face and moving down to the chest, abdomen, legs and finally to the palms of the hands and soles of the feet. The whites of the eyes or the inside of the mouth or gums may also look yellow. Sleepiness and poor feeding may also be present in infants who have significant jaundice.

How is jaundice diagnosed?

Your child’s doctor will look for visual signs of jaundice, as well as consider other factors such as birth weight and gestational age, feeding since birth, and level of hydration.
A blood test to measure the level of bilirubin in your baby’s blood, called serum bilirubin level (SBR), may be ordered. This is the most accurate way to measure an SBR and involves collecting a small amount of blood from the arm, hand, head or heel.
Additional blood tests or urine tests may also be ordered if there is evidence your baby’s jaundice is caused by an underlying disorder that will need treatment.

Will my baby need treatment?

Mild jaundice often goes away without treatment, however babies with high levels of bilirubin may require treatment. Treatment may include phototherapy, exchange transfusion or medication.

How does phototherapy work?

Phototherapy is very safe and effective in reducing SBR levels. As bilirubin absorbs light, jaundice and increased bilirubin levels usually decrease when the baby is exposed to these special blue coloured lights. The lights help the bilirubin in the blood to change so it can easily be eliminated from the body in the urine and faeces. Phototherapy may take several hours to begin working and is used throughout the day and night.

Types of phototherapy

Your baby will receive phototherapy from overhead lights or through a Biliblanket® or Bilisoft®.

Overhead lights – Your baby will be placed in a special cot called an isolette to keep him/her warm while a certain type of light is shone onto them. This light helps to break down the bilirubin, which will then be passed out of your baby’s body in their urine and stools.

Your baby will be placed under the light naked, apart from their nappy, to make sure that the light shines on as much of their skin as possible.

Eye pads will be placed over your baby’s eyes to protect them.

Bilisoft or Billiblanket – A fiber-optic pad with a special type of light that breaks down the bilirubin is placed directly against your baby’s back to make sure that the light shines on as much of their skin as possible. Your

baby may still wear clothing and wraps over the outside of the pad as normal. Your baby is able to feed while the treatment is taking place.

What will happen while my baby is having phototherapy?

A doctor or phlebotomist will take a blood test to measure the amount of bilirubin in your baby’s blood at least once a day.

You will be encouraged to take your baby out from under the light for short breaks for feeds, nappy changes and cuddles. You can usually continue to breastfeed your baby during phototherapy. If your baby’s bilirubin level is very high, more than one lamp will be used at the same time and your baby will need to stay under the lamps without breaks.
The nurses will monitor your baby’s feeding closely to make sure they are feeding enough.
The nurses will monitor the wet nappies and bowel motions from your baby, by weighing them and documenting to enable ongoing assessment.
Your baby will be lying on their back under the phototherapy lights, this is recommended for safe sleeping.
Your baby will be weighed each day to allow the nurses to monitor fluid status
Your baby’s temperature will be checked regularly to prevent him/her from becoming too cold or hot.

What will happen if the phototherapy doesn’t work?

In majority of cases phototherapy is very effective in reducing bilirubin levels. In very rare cases an exchange transfusion may be required to reduce the bilirubin levels. These are usually done in intensive care environments.

Side effects of phototherapy

Minor side effects may include

Loose, green bowel motions
Dehydration
Skin rash

Phototherapy may increase fluid loss; if you are breastfeeding you will be encouraged to continue to breastfeed your baby at least 8 to 12 times a day. This will help increase your milk supply, and decrease your baby’s bilirubin levels. Increased feedings will increase bowel movements, which will help remove the bilirubin. A lactation consultant is available in the hospital if you require any assistance

with breastfeeding. If your baby is unable to feed enough the nursing staff can give extra fluids either by oral, nasal gastric or intravenously to make sure your baby is hydrated.

If you have questions about your baby’s treatment or condition, please ask the nurse or the medical team caring for your baby.

Does jaundice cause any long-term problems?

For most babies, jaundice does not cause any long-term problems. In very severe cases, the amount of bilirubin in a baby’s blood is so high that it can damage parts of the brain including parts that affect hearing, vision and control of movement (this is called kernicterus). With the right treatment this small risk is reduced even further.

Going home

When your baby’s SBR reaches a safe level, phototherapy will be stopped. At this time your baby may still appear jaundiced, this is not uncommon. It may take two to three weeks for jaundice symptoms of skin discolouration to disappear after phototherapy has stopped. Before you go home with your baby, the doctors and nurses will make sure your baby is alert and feeding well.

Seek medical advice if:

The jaundice lasts more than two weeks in a term baby and three weeks in a preterm baby
Your baby’s skin becomes more yellow
Your baby’s bowel motions are pale, chalky coloured
Your baby’s urine is dark coloured, not as many wet nappies as usual
Your baby is not feeding well
Your baby isn’t gaining weight, seems listless or difficult to wake

Contact us

Division of Medicine/General Paediatrics Service
501 Stanley Street, South Brisbane 4101
t: 07 3068 1111 (general enquiries)

In an emergency, always call 000.

If it’s not an emergency but you have any concerns, contact 13 Health (13 43 2584). Qualified staff will give you advice on who to talk to and how quickly you should do it. You can phone 24 hours a day, seven days a week.

References:

Children’s Hospital Boston. (2006). Jaundice. http://www.childrenshospital.org
GE Healthcare. (2009). Phototherapy. www.gehealthcare.com
Hockenberry, M., & Wilson, D. (2007). Wong’s nursing care of infants and children (8th edition). Missouri: Mosby, Inc. LifeTronics Medical Inc. (2005). Bringing Techology to life, viewed 4 September 2009 www.lifetronics.com
Mater Health Services. (2009). Jaundice in newborn baby. (MHS-WCH-W-N-138) Milliman Incorporated. Milliman Milliman Care Guidelines -Neonatal Jaundice (16th edition). Seattle: 2012.

National Institute for Health and Clinical Excellence (2012). Jaundice in newborn babies: information for parents and carers. Accessed 22nd August 2012. Queensland Maternity and Neonatal Clinical Guideline (2012). Neonatal jaundice. http://www.health.qld.gov.au/qcg/documents/g_jaundice5-1.pdf
Clinical Practice Guidelines. Jaundice in early infancy. RCH. 2009. http://www.rch.org.au/clinicalguide
Wong, R. J. & Bhutani, V. K. (2009). Patient Information: Jaundice in newborn infants.

A Practical Approach to Neonatal Jaundice. American Family Physician. May 2008; 77 (9): 1255-1262.

Neonatal Jaundice: prevention, assessment and management. Queensland Maternity and Neonatal Clinical Guideline, Nov 2009. www.health.qld.gov.au/qcg

Jaundice shows up in babies as a yellowish tinge to the skin and eyes.
Jaundice is very common in newborn babies – about six out of 10 newborns have jaundice to varying degrees.
Jaundice is caused by an excess of a chemical called bilirubin.
Most jaundice is ‘physiological jaundice.
Physiological jaundice will resolve by itself once the baby's liver is functioning at full speed.
In babies where jaundice levels are very high in the days after birth, treatment using blue lights (phototherapy) may be required.
Other less common causes of jaundice include blood group differences between mother and baby, haemolytic anaemia, hepatitis and galactosaemia.

Newborn babies are often affected by jaundice, which makes their skin and eyes have a yellowish tinge. Jaundice is caused by a build-up of a chemical called bilirubin in the baby’s blood and tissues. Bilirubin is normally processed by the liver, but a newborn's liver takes a few days to process it, so about six out of 10 newborns have some degree of jaundice. The condition is more common among premature babies. This normal process results in what we call ‘physiological jaundice’.

Jaundice usually appears on the second or third day. If your baby is full-term and healthy, mild jaundice is nothing to worry about and will resolve by itself within a week or so. However, a premature or sick baby or a baby with very high levels of bilirubin will need close monitoring and medical treatments.

Occasionally, underlying blood and liver conditions can also cause jaundice in babies. These conditions include blood group antibodies, haemolytic anaemia, hepatitis and galactosaemia.

Symptoms of jaundice in babies

The symptoms of jaundice in babies depend on the cause and severity, but may include:

a yellow tinge to the skin, usually appearing first on the face and scalp
a yellow tinge to the white parts of the eyes (sclera)
a yellow tinge spreading to the skin of the body (in moderate jaundice)
palms of the hands and soles of the feet turning yellow (in severe jaundice)
unusual drowsiness
feeding difficulties
in some cases, light-coloured faeces (poo) and dark urine.

Talk to the maternity staff if you have any concerns about your baby showing any of these symptoms.

Physiological jaundice

Bilirubin is a waste product of the body’s break-down of old and damaged red blood cells. The liver helps to eliminate bilirubin as waste. In the mother’s uterus, the baby's bilirubin is sent down the umbilical cord and eliminated by the mother's body. After birth, the baby's liver has to eliminate the bilirubin itself, and it can take a few days for the liver to function at full speed. In the meantime, the excess bilirubin in the baby's body causes symptoms of jaundice.

Every newborn has elevated bilirubin levels, and around 60 per cent of full-term babies will have noticeable symptoms. Treatment isn't usually necessary, unless the baby has very high bilirubin levels, or is premature or sick. Dehydration (loss of water) or poor weight gain can make jaundice worse.

More rarely, jaundice may be caused by the following conditions:

Treatment for jaundice in babies depends on the cause, but may include:

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