Know the signs.
Jaundice is not uncommon in babies. When should you be concerned? Experts at Gastroenterology Service, KK Women’s and Children’s Hospital (KKH) tell you more.
What is jaundice?
If your newborn baby’s face or eyes have taken on a yellowish tint, do not be alarmed. Your baby may be suffering from jaundice, a mild medical condition that affects about 50 per cent of full term babies in the first week of life and about 80 per cent of premature babies. Jaundice in newborn babies usually begins on the second or third day after birth. It may last for a week and will clear up on its own.
“Jaundice begins at the head and progresses downwards. It is usually detected first in the whites of the eyes or face, then progresses to the chest and stomach and finally to the legs,” says Dr Christina Ong, Head and Consultant, Gastroenterology Service, KK Women’s and Children’s Hospital (KKH), a member of the SingHealth group.
Jaundice that progresses rapidly or persists beyond 14 days requires further evaluation to rule out a serious underlying condition. Dark urine and pale stools may be alarming symptoms of jaundice in newborn babies and need to be highlighted to a doctor.
What causes jaundice in newborn babies?
Jaundice in newborn babies is caused by excess bilirubin in the blood. Bilirubin is a product of the normal breakdown of red blood cells, and typically passes through the liver into the intestines, where it is excreted as bile.
“Jaundice occurs when the bilirubin increases faster than a newborn’s liver can break it down and remove it from the body,” explains Dr Ong.
Common causes of jaundice in newborn babies include the following:
The liver may be immature and unable to remove adequate bilirubin from the bloodstream.
More bilirubin is produced because of a higher turnover of red blood cells.
The amount of bilirubin reabsorbed from the intestines may be more than the baby can excrete.
Substances in breast milk may block protein in the liver from breaking down bilirubin. This is known as breast milk jaundice.
“Breast milk jaundice occurs in about two per cent of breastfed infants. It may start within the first week and improve over one to two months,” says Dr Ong.
“Jaundice begins at the head and progresses downwards. It is usually detected first in the whites of the eyes or face, then progresses to the chest and stomach and finally to the legs,”
When can jaundice be severe and lead to complications in newborn babies?
Jaundice in newborn babies may be severe if the baby is premature or if there is blood-group incompatibility between the mother and her baby.
Infections and inherited blood disorders and deficiencies, e.g. G6PD deficiency, can also place additional stress on the liver, causing severe jaundice in newborn babies.
Severe jaundice in newborn babies may lead to damage to the brain, a condition known as kernicterus.
Can older children get jaundice?
Jaundice is less common in older children. Older children may get jaundice if they suffer from any of the following medical conditions:
- Viral hepatitis
- Autoimmune disease
- Metabolic disease
- Biliary tract disorders
- Blood disorders
“Inherited blood disorders such as thalassaemia result in increased red blood cell breakdown, and may predispose the child to gallstone formation, which can lead to jaundice,” says Dr Chiou Fang Kuan, consultant, Gastroenterology Service, KK Women’s and Children’s Hospital (KKH), a member of the SingHealth group.
“Maternal hepatitis B or C carriage, ingestion of contaminated shellfish and exposure to certain viruses in the community may also predispose the child to viral hepatitis.”
Certain drugs and medications, including alternative remedies, can be associated with liver damage and jaundice.
Older children with jaundice who have a chronic disease such as thalassaemia or auto-immune disease may suffer from impaired growth and development.
“Parents are discouraged from directly exposing their babies to the sun because it may result in sunburn and dehydration that may worsen the jaundice,”
How is jaundice treated?
A blood test measuring the bilirubin level can confirm the severity of the jaundice. In older children, further investigation needs to be carried out to determine the cause of jaundice. Jaundice treatment varies depending on its cause and severity.
Babies with mild jaundice don’t require treatment but parents need to ensure that the baby is feeding well and is well hydrated. A breastfeeding mother should continue breastfeeding her jaundiced baby.
“Parents are discouraged from directly exposing their babies to the sun because it may result in sunburn and dehydration that may worsen the jaundice,” says Dr Chiou.
For severe jaundice in the first few days of life, treatment options include the following:
Phototherapy (light therapy): This promotes excretion of bilirubin.
Blood exchange transfusion: This clears the bilirubin from the blood and is used when the risk of kernicterus is high.
Early surgery is required in the baby who had obstruction to the bile flow from the liver to the intestine (a rare but serious condition known as biliary atresia). These babies present with jaundice that persists beyond two weeks old and is commonly associated with pale stools.
In older children, jaundice treatment is directed towards the underlying cause of the disease.