Baby—jaundice and phototherapy
Jaundice in the newborn baby is common and occurs in approximately 60 per cent of births. It is noticed as a yellow colouring of the skin and the whites of the eyes. Jaundice usually begins to fade by the end of the first week after birth without any problems. Jaundice can occur in babies of any race or colour, though it can be harder to see in babies with darker skin.
In the human body, new blood is being made all the time and old blood is being destroyed. One of the waste products when red blood cells are destroyed is “bilirubin”. Bilirubin is normally processed in the liver and is removed from the body in the urine and bowel motions.
For the first few days after birth, a baby’s liver is not fully functioning. It takes time to fully establish feeding so bilirubin can pass freely into the bowel. This means that there can be a build up of bilirubin in the blood and under the skin, called “jaundice”. Jaundice usually occurs first in the face and then moves to the chest, abdomen, arms and legs as the bilirubin level increases.
To help prevent jaundice from occurring or getting worse you will be encouraged to feed your baby as soon as possible after birth and after that frequently. You can also place your clothed baby near the window in natural light—never in direct sunlight as your baby can get sunburnt—natural light helps the body deal with the extra bilirubin.
Babies more at risk
Jaundice can occur in all newborns, however babies who may be more at risk of jaundice include:
- premature babies
- babies with an infection
- babies with bruising
- babies who have different blood groups or types from their mothers. This may result in antibodies developing and breaking down the baby’s red blood cells. There are too many red cells being broken down for the baby’s body to cope with.
If the level of bilirubin in the blood rises to a very high level, it can damage parts of the brain that are used for hearing, thinking and control of movement (called kernicterus). Kernicterus may result in deafness and physical and intellectual disability. The level of bilirubin that is harmful depends on how mature and how well your baby is. A large, full term, healthy baby can have higher levels without problems, compared to a sick or premature baby. To prevent any chance of health problems occurring we treat moderate levels of jaundice as this prevents the bilirubin from level rising to a dangerous level.
The level of jaundice is assessed carefully by the midwife and the paediatrician. A blood test may be necessary to measure the bilirubin level (SBR).
Moderate jaundice is treated with bright fluorescent/ bluish coloured lights called phototherapy. These lights break down the bilirubin in the skin and make jaundice fade. Your baby may be placed in a nappy under lights (overhead phototherapy) or on a blanket of fiberoptic lights (biliblanket).
Overhead phototherapy treatment is normally carried out in your hospital room. You are encouraged to care for your baby with the help of your midwife. Sometimes it is safe for a jaundiced baby to have phototherapy at home with a biliblanket.
If your baby is placed under phototherapy a blood test may be taken at least once each day to check the level of bilirubin in their blood. The bilirubin level will usually decrease every day with the treatment. The phototherapy may sometimes cause your baby to have brown coloured urine and loose brown/green bowel motions. These are signs that the treatment is working and the bilirubin level is decreasing. Your baby should be encouraged to feed every three to four hours as this helps to decrease the jaundice.
Babies are often sleepy when they are moderately jaundiced and may not feed well. We encourage you to ask for help from the midwife if your baby needs more time than usual to feed. You will also need to tell your midwife if your baby is not feeding at least every four hours.
Each time your baby is fed, their temperature should be checked. A baby’s temperature is normally between 36.5 and 37.2 degrees Celsius. It is important to check that your baby does not become hot or cold under the phototherapy lights. If they are on a biliblanket you may need to change the amount of clothes or number of blankets on your baby depending on their temperature. If your baby does become cold under overhead phototherapy, we can care for them in an isolette/humidicrib until they can maintain their own temperature.
A protective mask will also be placed over your baby’s eyes to shield them from the bright lights if they are having overhead phototherapy. The eye mask should be removed during feeds to encourage eye contact between you and your baby.
It is important that your baby remains under phototherapy lights for as much time as possible each day. Please try to only take them out from under the overhead phototherapy lights for feeds. When on a biliblanket, your baby can remain on the biliblanket while feeding.
Jaundice often takes about two weeks to disappear. If your baby is still jaundiced at three weeks please see your baby’s doctor.
Further information and support
If you have any questions regarding jaundice or phototherapy treatment please ask your midwife or paediatrician.
© 2014 Mater Misericordiae Ltd. ACN 096 708 922
Mater acknowledges consumer consultation in the development of this patient information.
Last modified 28/10/2015.