It seems almost like a rite of passage for many new mums: A few hours or days after your baby’s birth, you see a tinge of yellow in his skin and eyes. Known as jaundice, it’s one of the “most common conditions requiring medical attention among newborns, though it’s usually not a problem”, notes Dr Dharshini Gopalakrishnakone from The Obstetrics and Gynaecology Centre, a Singapore Medical Group Clinic.
Recalling her experience, one mother, Jasmine Tay, says that the day her infant son Isaac was due to be discharged, the nurses said that he couldn’t go home because his jaundice levels were high. “His skin was very yellow. Being a first-time mum, I was already very anxious, so I broke down in tears. I was very stressed out as I didn’t know then how common jaundice is.”
Isaac, was warded for two more days, so that he could get phototherapy treatment until his levels dropped. In the meantime, the new mother expressed breastmilk religiously at home, which her husband then delivered to the hospital “It broke my heart to see him crying in the phototherapy machine, but I had to trust the doctors to take care of things. Of course, I was upset that he couldn’t come home with me, but deep inside, I knew that I had to do what was best for his health.” Now 2, Isaac is perfectly healthy.
“I was very stressed out as I didn’t know then how common jaundice is.”
What is newborn jaundice?
Newborn jaundice happens when there is too much bilirubin in the baby’s blood. This is a yellow substance that’s made when the body breaks down old red blood cells. “Newborns make more bilirubin than adults because they have a higher turnover of red blood cells,” Dr Dharshini explains.
When you are pregnant, your body helps to remove bilirubin from your baby’s blood through the placenta. But once your baby is born, his body must get rid of the bilirubin on its own. To check if your baby has the condition, examine him in natural daylight and look for yellowing of his skin or the whites of his eyes.
“Gently press your fingers on the tip of his nose or on his forehead ― if the skin looks yellow where you pressed, it’s likely that your baby has mild jaundice. If your baby doesn’t have jaundice, the skin colour should simply look slightly lighter for a quick moment,” Dr Dharshini notes.
In the hospital, a quick blood test (your baby’s heel is pricked) will determine if your baby has jaundice. The doctor will decide if treatment is necessary based on the bilirubin level in his blood.
Check out the different types of newborn jaundice:
Physiological jaundice The most common type of jaundice in babies, it can affect up to 60 per cent of full-term babies in their first week of life. It’s usually most evident when the baby is two to four days old. It usually isn’t serious and goes away within two weeks.
Breastmilk jaundice This type of jaundice is seen in healthy breastfed babies, usually after baby is a week old. It likely peaks during week two or three. “There is no known cause for breastmilk jaundice, although speculation is that it may be linked to a substance in the breastmilk that is blocking the breakdown of bilirubin,” says Dr Dharshini.
Breastfeeding jaundice This happens when baby is not getting enough milk. Explains Dr Dharshini, “Adequate amounts of breastmilk increase a baby’s bowel movements, which help secrete the buildup of bilirubin.” This condition arises when a newborn does not get a good start on breastfeeding, possibly due to a poor latch or if the mother’s milk is slow to come in. “Breastfeeding jaundice will often resolve itself with increased feedings and help from a lactation consultant to make sure the baby is taking in adequate amounts [of breastmilk],” Dr Dharshini notes.
Blood group incompatibility-related jaundice If a baby and his mother have different blood types, the mother may produce antibodies that destroy the newborn’s red blood cells. “This usually occurs during the first 24 hours of the baby’s life, and is caused by a sudden buildup of bilirubin in the baby’s blood,” notes Dr Dharshini.
Your baby is more likely to get newborn jaundice if you had gestational diabetes mellitus, if he has an excessive number of cells in his blood, a specific enzyme deficiency or a metabolic disease. He’s also at a higher risk if he was a premature baby or a low birthweight baby, or if he had certain infections at birth, Dr Dharshini adds.
Treatment of jaundice
Most cases of newborn jaundice do not require treatment, Dr Dharshini says. “It will usually go away after a week or two, as the baby’s body becomes able to get rid of the excess bilirubin on its own,” she adds.
The mother may also be advised to increase her breastmilk feedings, or supplement with formula to help the baby to pass the bilirubin out in his stools.
Stopping breastfeeding is seldom an effective treatment for jaundice in a breastfed baby.
Make sure that your baby is latching on well, and is taking in adequate amounts of milk. “It’s important to work with a lactation professional,” says Dr Dharshini. Stopping breastfeeding is seldom an effective treatment for jaundice in a breastfed baby, she adds.
You can increase feedings to eight to 12 times a day, pump to express more milk, or use a lactation aid to avoid any problems in the breastfeeding relationship, Dr Dharshini adds.
For higher levels of jaundice, phototherapy may be recommended. She explains, “The light converts the bilirubin molecules into water soluble isomers that are easier for your baby’s liver to break down and remove from his blood.”
What happens if the jaundice doesn’t go away? Read on…
It’s rare, but in cases where baby’s high bilirubin level isn’t treated, this could cause brain damage (kernicterus), leading to serious lifelong problems for the child.
“Bring your baby to the doctor immediately if he is getting more yellow, becoming sluggish and excessively sleepy, cranky or jittery, not feeding well, develops a high pitched cry, or starts to arch his back in an unusual way,” stresses Dr Dharshini. These signs point to a more serious case of jaundice that warrant immediate attention.
In cases where baby’s high bilirubin level isn’t treated, this could cause brain damage (kernicterus), leading to serious lifelong problems for the child.
Can jaundice be prevented?
If you have gestational diabetes, make sure this condition is under control during your pregnancy to reduce the likelihood of your newborn getting jaundice. “Also, make sure you follow up with your gynae to look out for possible low birthweight, or risks of preterm labour,” Dr Dharshini adds.
After delivery, make sure your baby gets enough milk. If you aren’t sure whether your baby is getting enough milk, ask your doctor or lactation consultant for help.
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