While most children getting jaundice recover without
much of a problem, some of them may need serious attention. Doctors get really concerned under the following
appearing within 24 hours after birth.
child with jaundice who appears unusually sick, drowsy and anaemic or one who develops altered
behaviour, or a bleeding tendency, or swelling of the body, or persistent vomiting with dehydration.
Physiological Jaundice In A Newborn Baby
Most jaundiced babies have what is known as normal or physiological jaundice. The jaundice
after 30 hours of birth, gradually deepens and disappears on
the 10th day. This happens due to slight immaturity of the
baby’s liver. The child generally does not require any
treatment. If the jaundice is severe, your doctor may like to rule out
certain other causes of jaundice like an infection or rare
causes like thyroid deficiency or galactosaemia — a rare inborn
error of metabolism. Babies with galactosaemia are born with intolerance to
galactose, one of the two sugars that
make up the lactose present in milk.
The level of jaundice is known by estimating the level
of serum bilirubin (the yellow pigment produced by the breakdown of red blood cells). In physiological
jaundice, the bilirubin level usually does not exceed 20 mg./dl. In
Indian and other Asian children, it may reach 25 mg./dl. without
causing any problem to the child.
In case of high levels, your doctor may like to estimate
the level of haemoglobin and may again test for bilirubin. A
rise of 0.5 mg./dl. of bilirubin or more per hour or a falling haemoglobin level may need some intervention. Children
who are born normally without any problem are usually quite
safe, but those who are born prematurely or had lack of
oxygen, low blood sugar or accumulation of acids in the body (acidoses) need extra care.
Some jaundiced babies are sleepy and may not suckle too well or too often.
MANAGEMENT: Frequent suckling is the best way to reduce the incidence of jaundice and
to treat it as
well. Bilirubin is present in large amounts in the meconium
— the baby’s first stools. If the meconium is not cleared,
the bilirubin gets reabsorbed into the baby’s system. Colostrum (the first breast milk) helps to clear meconium and thus
assists in the prevention of jaundice. If your baby gets
enough breast milk, it helps to clear early jaundice. Giving glucose water, plain water or other supplements does not help.
Such drinks interfere with breastfeeding and can increase the jaundice.
The best way you can help your baby with jaundice is by breastfeeding him frequently,
whenever he is hungry (demand feeding) during the day or at night. If he is
unusally sleepy, try to stimulate him every 2 hours. If he does
not oblige, report to your doctor who may ask you to express
your milk and give it to the baby with a small glass or bondla (paladai) every
Late Onset Jaundice In A Newborn Baby
Sometimes, jaundice starts at the end of the first week
of life in an otherwise healthy baby and may last up to 3 to 10
weeks of age. Often, this prolonged jaundice is not serious and
is due to the presence of a harmless substance in the mother’s
milk. That is why it is also sometimes labelled ‘breast milk
jaundice’. It tends to recur in the next child. This jaundice is harmless and
clears without any treatment. The baby continues to
suckle well and gains weight normally. If the jaundice is very
severe, especially if the baby looks unwell, your doctor may
consider the possibility of the child having some other
TREATMENT: The doctor may suggest temporary stoppage of breastfeeding to confirm the diagnosis of
late onset jaundice. This would bring down the levels
quickly, but do not agree to this suggestion too readily. In such a
situation, you have the following options:
- Express your milk. Boil it and give it to your baby
by a bondla. Heating breast milk reduces the levels of bilirubin.
- Stop breastfeeding temporarily for 12 to 48 hours
and give breast milk from another HIV-negative mother or from a breast milk bank*. Keep expressing your milk
and discard it.
- Alternate artificial milk feeding and breastfeeding
for 24 to 48 hours. I prefer this approach in anxious
- Continue breastfeeding normally and give
phototherapy (light therapy).
- Replace breastfeeding by artificial milk feeding for
12 to 48 hours while observing the reduction of bilirubin and the level of jaundice.
The moment the period of 12 to 48 hours is over, you
must start breastfeeding normally again.
Very high levels of bilirubin can cause damage to the
brain of a newborn baby. But no such damage has ever been reported due to late onset jaundice.
It is important to realise that even if a baby needs treatment (usually light therapy) for
jaundice, you must continue to breastfeed your baby normally.
*Breast Milk Bank, C/o Head, Department of Neonatology,
Lokmanya Tilak Municipal Medical College, Sion, Mumbai 400 022.
Light therapy (phototherapy) is based on the principle
that exposure of the skin to blue or fluorescent tube light,
or daylight, converts bilirubin in a manner that it can be eliminated more easily from the body.
The baby is put under the light without clothes, with
his eyes covered to prevent damage. The light is kept approximately 45
ems. above the infant. To avoid undue
separation from your baby, you can request the nursing
staff to bring the phototherapy unit next to your bed. If that is not possible, you should keep going to where the unit is
kept and breastfeed your baby whenever he is hungry. Remove the cover from the baby’s eyes while breastfeeding.
Some babies may get loose motions while under the
lights. This is normal. Others become a little irritable to
begin with. Some may develop the so-called ‘dehydration fever’
due to loss of water from the body. You may be tempted to give water to the baby for this reason. This
avoided. Frequent breastfeeding will provide the required amount
of fluids in most cases.
For daylight, do not draw the curtains in your room.
Direct sunlight can cause sunburn. But keeping the baby in the
sun at about 10 a.m. for about 10 minutes, where possible,
is advisable. This also helps in conversion of pro-Vitamin
D in the baby’s skin to Vitamin D.
Jaundice Due To Blood Group Incompatibility
Rh incompatibility and ABO incompatibility between the mother and the foetus can result in
jaundice in the newborn baby.
Your doctor will get your blood tested during pregnancy
to find out if you are Rh-negative. If so, your baby will
be observed closely for appearance of jaundice and for the
rate of rise of bilirubin and his level of haemoglobin. Your
doctor may also give you a special injection within 24 to 72 hours
after delivery to prevent any trouble to your next baby.
ABO incompatibility is a relatively milder disease. The common combination is an 0 group
mother and A or B group foetus.
An exchange transfusion is undertaken mostly in Rh incompatibility if the haemoglobin
estimation of the
cord blood of the baby is low or his cord bilirubin is high,
or if the bilirubin levels after birth cross the safe levels.
It may also have to be undertaken in certain other situations like a whose
rise rather rapidly or babies with jaundice who also have
added problems like infection, low blood sugar, etc.
Other Causes Of Jaundice In A Newborn Baby
Infections in a newborn baby are rare. Conditions like hypothyroidism and galactosaemia can
also cause jaundice
in the newborn.
Any jaundice that persists for over two weeks may need detailed investigations. If the child
has white stools,
it may be due to the flow of bile being obstructed. Such a child
needs the urgent attention of a paediatric surgeon.
Jaundice In Older Children
CAUSES: The two common causes of jaundice in older children are infections or drugs
affecting the liver.
Certain drugs given for tuberculosis and epilepsy can cause
jaundice. The common infections causing jaundice are hepatitis and malaria. In malaria, the child with
jaundice may have
very low haemoglobin. He is often very anaemic and may need blood transfusion.
11 February, 2013