Iris Lapinski reports on an unexpected problem as a new parent

When my children were born they both suffered from jaundice, so I compiled some information for other parents in the same position.

What is neonatal jaundice?

Neonatal jaundice is a common condition affecting 50-60% of all babies during the first week of their life. It is caused by:
a) the breakdown of foetal haemoglobin (a protein carrying oxygen in red blood cells) as it is replaced by adult haemoglobin, so creating a substance called bilirubin as a side product
b) the immature liver function of newborns so they areunable to excrete bilirubin as quickly as an adult.

While most cases of neonatal jaundice are mild and harmless and typically resolve themselves during the first two to four weeks of a baby’s life, prolonged high bilirubin levels can result in a condition called Kernicterus, a bilirubin-induced brain dysfunction which can potentially cause irreversible neurological damage. New babies are especially vulnerable to this and therefore must be carefully monitored for alterations in their blood plasma bilirubin levels.

How do hospitals treat jaundice?

The type of treatment depends on the severity of the jaundice as well as whether your baby is pre-term or not.
a) Baby only has mild jaundice. No special intervention is needed and jaundice should disappear after two to four weeks.
b) Baby is very heavily jaundiced at birth. Immediate action is required to reduce bilirubin levels before it can do harm. Typically, this is achieved by an exchange transfusion at the neonatal care unit, where some of the baby’s blood is removed and replaced by saline solution, effectively diluting the levels of bilirubin in the blood. Once the transfusion is completed, bilirubin levels should be at strong jaundice levels and treated with phototherapy
c) Baby is strongly jaundiced shortly after birth. In this case the baby will require phototherapy, ie exposure to blue light which helps break down bilirubin, using an overhead light or Biliblanket – see photos. The overhead lights are stronger and require the baby to strip under a makeshift incubator, whereas the Biliblanket offers less blue light, only at the back, and allows the baby to wear normal clothing
During all treatments the bilirubin level is monitored via blood tests every six to eight hours. Results are plotted on a chart and only if consistently below the phototherapy treatment line over time is treatment stopped.

How long is treatment?

There is no fixed guidance on treatment duration, but most babies with very heavy jaundice are treated for five to seven days with combined exchange transfusion and phototherapy. Babies with strong jaundice are treated with phototherapy for only two to five days and the hospital will want to monitor the baby after stopping phototherapy so both mother and baby may have to remain in hospital for seven to 10 days after birth.

What you can do to help your baby?

It is important to calm and support your baby when it needs to lie in an incubator or underneath overhead lights. Many find this experience stressful andcuddling the head will console and settle them. Even if it can be hard to see your baby crying in the incubator, don’t worry: babies get used to this treatment after a while and then hopefully sleep quietly underneath the lights. If your baby is very distressed take it out and give it a cuddle to calm down.

Second and crucially, ensure that your baby feeds regularly every two to three hours as this will help flush out bilirubin faster by passing urine. As many jaundiced babies get very tired and tend to feed less, it’s your job to wake your baby up (change nappy or wash face with cold water) and feed. If your baby is being treated by overhead lights, only take them away from them when feeding to ensure maximum exposure.
Third, keep your baby warm. This especially applies to the overhead lights in a makeshift incubator. Close the beginning and end of the tube with towels so that your baby stays warm.

Common signs of jaundice

Beyond blood tests on the baby’s bilirubin levels, the best known sign of jaundice is the yellow colour of the eyes and skin, but sleepiness and loss of appetite are also markers.

If you are worried by changed behaviour in your baby after you have left hospital, do contact your GP. He/she might also check for other causes of yellow skin such as liver malfunction.