Newborn Jaundice is the yellowish discolouration in the skin and whites of the eyes of newborn babies in the first month. It is caused by increased levels of pigment (bilirubin) in the blood.
Red blood cells, and how bilirubin is produced and excreted in the body:
- The body's red blood cells break down and release bilirubin and other by-products.
- Bilirubin is converted into a harmless substance in the liver.
- The harmless substance is then excreted in faeces and urine.
The cause for excessive bilirubin:
Bilirubin is released during the normal breakdown of red blood cells in the body. The newborn's liver may not be able to cope with the amount of bilirubin that is being produced. Therefore, bilirubin is accumulated in the newborn's body, resulting in a condition known as physiological jaundice.
Most cases of newborn jaundice belong to this category where the jaundice disappears without treatment in 1 to 2 weeks, so parents need not worry. However, if the blood bilirubin rises rapidly to an unusual high level, it may enter the brain cells and cause damages, a condition known as"kernicterus". It may lead to hearing loss, mental retardation, spasticity or even death. Therefore, parents are advised to bring their baby to the nearby Maternal and Child Health Centre for assessment soon after discharge from hospital. If necessary, follow-up should continue until the jaundice has disappeared.
Consult the doctor immediately if baby has the following symptoms:
- Rapidly increasing jaundice (yellowing of the skin and whites of the eyes).
- Decreased appetite for milk.
- Signs of dehydration, such as a noticeable decrease in number of wet nappy per day.
- A noticeable decrease in activity level.
G6PD deficiency can lead to jaundice
Glucose-6-phosphate dehydrogenase (G6PD) is an important enzyme for stabilizing the red blood cells. G6PD deficiency is inherited. In Hong Kong, around 4.5% of baby boys and 0.5% of baby girls are G6PD deficient. When exposed to certain food, Chinese herbal medicines or drugs, Naphthalene and Naphthalene-containing products, or infected by certain viruses, their red blood cells may be damaged in a large scale to produce excessive bilirubin, thus overloading the liver and resulting in severe jaundice.
Babies born in Hong Kong public hospital have umbilical cord blood test for G6PD deficiency. Parents will be informed if the baby is detected to have G6PD deficiency and relevant health information will be provided.
- Avoid Chinese herbal medicines such as Rhizoma Coptidis(黃蓮), Flos Chimonanthi Praecocis(臘梅花), Flos Lonicerae(金銀花), Calculus Bovis(牛黃), and Margarita(珍珠末). Avoid certain drugs such as nitrofurantoin, nalidixic acid and sulphonamides.
- The clothing of babies and their caregivers should not be exposed to Naphthalene and Naphthalene-containing products.
- Avoid eating broad beans.
Children with G6PD deficiency normally require no special care, but lifelong avoidance of certain food (broad beans), Chinese herbal medicines and drugs is essential. Breastfeeding mothers also have to avoid these drugs. When a G6PD deficient child is ill or admitted to a hospital, inform the medical staff of such deficiency for proper prescription. In addition, G6PD deficient children and their caregivers should avoid close contact with Naphthalene and Naphthalene-containing products, and children should avoid eating broad beans.
Babies may have newborn jaundice within first few days after birth. The condition may deteriorate suddenly in the first few weeks. Parents are advised:
- to phone Maternal and Child Health Centre or your family doctor soon after discharge and arrange an earliest appointment to monitor the condition, or
- to bring baby back to hospital of birth for follow-up as instructed by your hospital medical or nursing staffs.
Questions frequently asked by parents
When discharged from hospital, the doctor said my baby was healthy.
Why is my baby jaundiced a few days later?
In most cases of physiological jaundice, the bilirubin level reaches its peak 3 to 5 days after birth. Therefore, it is likely for a newborn to develop jaundice after being discharged if the stay in hospital is short (1 to 2 days).
Is newborn jaundice caused by excessive personal contact?
No. Jaundice is not a communicable disease. It has nothing to do with personal contact.
Why are follow-ups at Maternal and Child Health Centre necessary?
When does a jaundiced baby need phototherapy?
As the degree of jaundice may fluctuate daily in the first few days, close monitoring of the condition at the Maternal and Child Health Centre is required. If necessary, the baby will be referred to the paediatric specialist for treatment such as phototherapy. As with other treatments, phototherapy can cause side effects. It is therefore given only when the bilirubin rises rapidly to a high level.
Can sunbathing help to decrease jaundice?
Sunbathing is not an approprite method to treat neonatal jaundice. Treatment for jaundice should be under medical supervision.
Does glucose water help?
Glucose water cannot alleviate jaundice. It may even make the condition worse by decreasing the baby's appetite for milk.
Do I have to stop breastfeeding and feed the baby with infant formula in order to alleviate the jaundice?
Newborn babies, whether breastfed or formula-fed, may develop jaundice. For babies who are breastfed, getting sufficient breastmilk will help alleviating the degree of jaundice and prevent dehydration. Correct feeding techniques and feeding as often as the babies want are the fundamentals of breastfeeding. Six or more soaked nappies a day will assure you that they are having enough milk intake. Some breastfed babies may have mild prolonged jaundice, but you can continue breastfeeding if your baby shows satisfactory weight gain (about 125g per week).
What should I do if my baby's jaundice persists?
If your baby's jaundice does not disappear after 2 to 3 weeks or baby's faeces turn into an abnormal colour (light gray), it may need to be referred to hospital for further examinations to rule out other underlying health problems such as congenital bile duct obstruction. When in doubt, please seek advice from medical and nursing staff of the Maternal and Child Health Centre. Follow up the newborn jaundice in your own country if your baby is not staying in Hong Kong.