Neonatal Jaundice. An information guide

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Cornelius Bailey
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1 TO PROVIDE THE VERY BEST CARE FOR EACH PATIENT ON EVERY OCCASION Neonatal Jaundice An information guide

2 Neonatal Jaundice This leaflet has been produced to explain to mothers and families about jaundice and its effects and treatment in the new-born baby. What is jaundice? Jaundice is very common in newborn babies. Up to 80% of newborn babies will become jaundiced 2 or 3 days after birth. It is caused by an increased level of Bilirubin in the blood which results in a yellow colouring of the skin and the whites of the eye. Jaundice does not usually mean your baby is ill. It is generally a normal process, which causes no harm to the baby, however, it is important that jaundice is watched carefully to ensure that the Bilirubin levels do not get too high as occasionally it could be due to liver problems which may require treatment. What causes it? Prior to the birth, your baby obtains its oxygen second hand (from your placenta). In order to capture sufficient oxygen for itself from your blood supply, the baby requires many red blood cells to carry the oxygen around its body. After your baby is born, it obtains its oxygen first hand (through its own breathing) and therefore, does not require the large amount of red blood cells in its system. Therefore, the excess cells are destroyed. In the destruction process (breakdown), a bi-product called bilirubin is produced. Bilirubin is yellow in colour and is attracted to fatty tissue, which can be found just under the skin and in the eyes of your baby. 2

3 Normally, bilirubin is made harmless by the liver, but in newborn babies the liver is immature and less able to cope. Therefore, excess bilirubin remains in the baby s blood stream and tissues until the liver can deal with it some days later. When does it occur? Jaundice occurs frequently in babies aged 2 to 3 days. If you or your midwife/doctor notice your baby is jaundiced after 2 days of life, arrangements will be made to measure it by doing a simple blood test. Most babies don t require any treatment. However, if you notice that your baby is jaundiced before 24 hours of age please contact your midwife, GP or postnatal ward (if you have gone home) URGENTLY as your baby will need to be admitted and offered earlier treatment and closer monitoring to avoid the complication of Kernicterus - a medical word for brain damage caused by excessive bilirubin in the brain cells. Sometimes jaundice continues after the baby is 14 days old in a full term baby and 21 days in a premature baby. This is called prolonged jaundice. This is more common in breastfed babies and is usually normal and does no harm. It is not a reason to stop breastfeeding. Blood and urine tests will be required to distinguish between breast milk jaundice, which may require further investigation and treatment. These are simple checks you can carry out. The stools of a breast fed baby should be green/daffodil yellow The stools of a bottle fed baby should be green/english mustard colour The urine of a new born baby should be colourless 3

4 If your baby s urine is yellow and/or the stools are pale this can indicate liver disease and you must report this to your midwife, health visitor or GP. Do not wait until after 14 days if you notice this at any point in time. Additional Factors Bruising, prematurity and poor feeding can cause the jaundice to be more pronounced. This is because the liver is under increased pressure and even more immature in these circumstances. Liver disease can also produce jaundice, which is why your baby will be monitored closely by your midwife, health visitor or general practitioner in order to ensure that the best possible treatment is given to your baby. Treatment - phototherapy Most babies don t require any treatment. Babies requiring treatment receive phototherapy which is equipment which delivers a bright fluorescent light which helps to break down the Bilirubin quicker. Your baby will be nursed under a bright fluorescent light with either a soft mask covering the eyes or an eye shield to protect them from the brightness. Alternatively your baby could receive treatment in a cot specially adapted to administer phototherapy. Your baby will be undressed and nursed only in a nappy whilst receiving treatment. Side effects of the phototherapy can be skin rashes and loose stools, so skin care is important. However, whilst under phototherapy it is advised that no creams or oils are applied to your baby as this may result in harmful damage to the skin. It may be possible for your baby to have phototherapy by your bedside so that you don t have to be separated (this may be different if your baby is nursed on the neonatal unit). Treatment may continue for a few days with breaks for feeds until the jaundice diminishes. We will monitor the levels of jaundice whilst on treatment every 6-12hrs by doing blood tests which may involve 4

5 taking blood from your baby s heel or hand. The results will also help us to know when this phototherapy treatment should be stopped. Some babies are unsettled whilst having phototherapy. Your midwife will help you to comfort your baby. Treatment exchange transfusion In rare and severe cases, if the jaundice gets worse, an exchange transfusion of blood may be needed. This is where some of your baby s blood is removed and replaced with blood that does not have such high levels of bilirubin. If this is required, your baby will be transferred to the Neonatal Intensive Care Unit at Oldham, Bolton or St Mary s (Manchester) where neonatal nurses and doctors, who are experienced in such techniques, can give you further information. The exchange of blood helps to prevent Kernicterus - the signs and symptoms of Kernicterus are irritability, drowsiness, and unusual movements of arms and sometimes fits. With detection and monitoring of jaundice, Kernicterus is rare. Remember: Jaundice is very common in newborn babies. Up to 80% of newborn babies will become jaundiced 2 or 3 days after birth and this will resolve naturally. However, occasionally the jaundice is due to liver problems which is why we ask you to tell your midwife or doctor if you have any concerns. Worries & Explanations Always ask about the treatment your baby is being given and why, if it is not explained to you. It is important that you understand what is happening so that you can work together with hospital staff to ensure that your baby receives the best possible care. It is natural to feel anxious if your baby is having special care. 5

6 Talk over any fears or worries with the ward or community staff caring for you and your baby. If you do have any concerns, please do not hesitate to contact your GP, midwife or the Post-Natal Ward. Postnatal ward Contact numbers- North Manchester Royal Oldham

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8 If English is not your frst language and you need help, please contact the Ethnic Health Team on Jeżeli angielski nie jest twoim pierwszym językiem i potrzebujesz pomocy proszę skontaktować się z załogą Ethnic Health pod numerem telefonu For general enquiries please contact the Patient Advice and Liaison Service (PALS) on For enquiries regarding clinic appointments, clinical care and treatment please contact and the Switchboard Operator will put you through to the correct department / service Date of publication: March 2012 Date of review: July 2014 Date of next review: July 2017 Ref: PI_SU_743 The Pennine Acute Hospitals NHS Trust Wood pulp sourced from sustainable forests

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