Newborn jaundice

What is it?

Newborn jaundice occurs when a baby’s immature liver isn’t sending the yellow pigment bilirubin (which is produced by the normal breakdown of red blood cells) to the intestines to be excreted at a normal rate. When bilirubin builds up in the body, it gives the baby’s skin and whites of the eyes a yellowish tint.

What causes it?

There are different kinds of jaundice:

• Physiological jaundice For the first few days of life, most babies have a little bit of physiological jaundice until the liver becomes fully active. This is the most common type of jaundice and it usually resolves itself within days.

• Incompatible blood types Jaundice can result when a mother and her baby have different blood types. If a mother is O positive, for example, and the baby has blood type A or B, the mother may produce antibodies that destroy some of the newborn’s red blood cells. This results in an increased amount of bilirubin and can cause more severe jaundice requiring treatment. Rh incompatibility problems are now preventable with an injection during pregnancy.

• Dehydration When breastfeeding isn’t going well and the baby isn’t drinking enough breastmilk, inadequate fluid intake makes it harder to excrete the bilirubin efficiently and can exacerbate jaundice.

How common is severe jaundice?

Most cases of jaundice are mild and resolve themselves without treatment. According to a study by the Canadian Paediatric Surveillance Program, in a two-year-period, 258 newborns in Canada were readmitted to hospital within five days of birth with severe jaundice. Gatineau, Que., paediatrician Danielle Grenier, medical affairs officer for the Canadian Paediatric Society (CPS), says, “When jaundice is severe, there is always a risk that the bilirubin can be toxic to the brain, a condition called kernicterus, which can lead to seizures, deafness and delayed motor development.”

That’s why the CPS recently recommended that all newborns be screened for bilirubin within 72 hours of birth and treated early if necessary. “If discharged home in the first 48 hours of life, newborns should also have a follow-up assessment within the next 48 hours by an experienced health care provider to identify feeding problems, weight loss or persistent jaundice,” says Grenier.

How is jaundice treated?

Breastfeeding helps treat jaundice because the bilirubin is absorbed and excreted through urine and stools, explains Toronto lactation consultant Edith Kernerman. That’s why it’s so important to get the breastfeeding technique right; new mothers need to make sure the baby is latching well at the breast and getting enough milk. “When breastfeeding goes well, mild jaundice will often disappear,” says Kernerman. If a baby is not drinking well, a lactation consultant can help the mother fix the latch and learn the difference between sucking and drinking to make sure feedings are effective.

Babies with severe jaundice may need phototherapy or light treatment, which reduces bilirubin levels by making the pigment easier to excrete.