Jaundice (Newborn)

Healthcare professionals at NUH provide daily assessment of newborns, offering guidance on the progress and understanding of newborn jaundice.

Jaundice manifests as a yellowish tint in the skin and eyes, caused by elevated levels of bilirubin, a by-product of the breakdown of red blood cells). The liver processes bilirubin, which is then excreted through stools and urine

Newborn jaundice typically presents as a yellow discolouration starting in the face and progressing downwards. The whites of the eyes may also display this yellowish hue. Jaundice itself usually has no other accompanying signs or symptoms.

However, very high levels of bilirubin can lead to excessive irritability, sleepiness or a lack of interest in feeding. If left untreated, severe jaundice can cause developmental brain damage.

• Physiological jaundice: Common in over half of all newborns, it results from the liver's immaturity, leading to slower bilirubin processing. It appears at two to four days, peaks around four to six days and resolves by two weeks of age.
• Breast milk jaundice: Occurs in a subgroup of exclusively breastfed infants around four to seven days of age and can persist for three to 10 weeks.
• Higher risk factors for jaundice:
• Blood group incompatibility (Rhesus or ABO) between mother and newborn, potentially causing rapid and early onset jaundice (by 24 to 48 hours of life).
• Glucose-6-Phosphate Dehydrogenase (G6PD) deficiency in newborns.
• Late preterm births (34 to 36 weeks) due to less mature liver.
• Newborns with bruising or cephalohaematoma from delivery.
• Newborns with a family history of severe newborn jaundice.
• Infants of mothers encountering breastfeeding challenges in the first week.

​Diagnosis

Newborns displaying signs of jaundice in the hospital may undergo a jaundice screening using a transcutaneous bilirubinometer. This non-invasive test is often followed by a confirmatory blood test via a heel prick.

Medical professionals will provide guidance based on the infant's age and bilirubin level. In some cases, phototherapy may be recommended before discharge. Parents might also be advised to have the infant's jaundice and feeding patters reviewed 24 to 72 hours post-discharge.

Seek medical attention if:

• Jaundice appears within the first 48 hours of life, progresses rapidly or persists beyond 14 days.
• Breastfeeding difficulties arise, and the infant shows inadequate stool and urine output, with increasing jaundice.
• The infant's stools are unusually pale or urine is dark and jaundice continues beyond 14 days.

Treatment

Blue-light phototherapy is the primary treatment for hospital-based jaundice. The infant remains under phototherapy lights for approximately 24 hours, with breaks for feeding and diaper changes. This treatment can be administered through overhead lights or a blanket-like device.

During phototherapy, some infants might require supplemental fluids. Breastfeeding should generally continue.  If separated from the infant, mothers are encouraged to express breast milk frequently to maintain supply and avoid engorgement.

In rare cases of rapidly escalating bilirubin levels, blood exchange therapy may be necessary to prevent potential brain damage.

It’s important to note that water or glucose feeds do not reduce jaundice. Sunlight exposure and herbal remedies are ineffective and potentially harmful. To aid bilirubin excretion, frequent breastfeeding is encouraged to stimulate bowel movements.

Post-phototherapy, infants may be discharged or monitored for bilirubin level changes. Follow-up appointments are often scheduled within one or two days for infants under seven days old to recheck bilirubin levels.