Jaundice is the yellowish discolouration of the skin caused by an increase of bilirubin in the blood.

 

What is jaundice?

Jaundice is the yellowish discolouration of the skin caused by an increase of bilirubin in the blood.

 

What is bilirubin?

Bilirubin is a pigment produced from the breakdown of red blood cells. It is then processed in the liver before being passed out into the stools.

 

How common is jaundice in babies?

Jaundice is very common and occurs in 50% of babies in the first week of life.

 

What causes neonatal jaundice?

1. Physiological Jaundice
   Physiological jaundice  is the most common cause of neonatal jaundice and is harmless to your baby. The onset of physiological jaundice is after the first 48 hours and will subside by the end of the first week of life. It is caused by the normal breakdown of red blood cells and the immaturity of the liver.  As such, late preterm babies of between 34-36 weeks are at higher risk of developing jaundice if they do not receive early treatment.
2. Pathological Jaundice
   Pathological jaundice – jaundice with onset in the first day of life is usually pathological. Causes includes:
   • Incompatibility between mother’s and baby’s blood group (in mothers with Rhesus negative or Blood Group O blood).
   • Babies with G6PD (glucose 6 phosphate dehydrogenase) deficiency in their red cells resulting in their instability on exposure to certain agents. This occurs in less than 5% of babies. All newborns are screened for G6PD deficiency at birth.
   • Infection in the newborn which makes the baby unwell and needs in-hospital treatment.

 

What causes jaundice in babies to be prolonged?

Jaundice is considered prolonged if it persists for longer than 14 days in a term baby and 21 days in a preterm baby. Common causes are:

• Breast milk jaundice – Babies on exclusive breastfeeding may have prolonged jaundice. As long as the mothers are not taking traditional herbs, the jaundice will be harmless to the babies.
• Urinary tract infection.
• Obstruction of bile flow from the liver into the intestine. This rare condition will result in pale coloured stools and dark or tea coloured urine.
• Congenital hypothyroidism – This condition occurs in 1 per 4000 babies. Currently the national screening programme of newborn cord blood for congenital hypothyroidism is an ongoing programme in all government hospitals and clinics.

 

Risk factors for severe Neonatal Jaundice?

• Baby born premature
• Low birth weight
• Jaundice within 24 hours of life
• Mother with blood group ‘O’ or Rhesus Negative
• G6PD deficiency
• Cephalhematoma or bruises
• Babies of diabetic mothers
• Family history of severe NNJ in siblings

 

What should I do if my baby has jaundice?

Consult your doctor or health nurse for a proper evaluation. However, your baby is likely to be healthy in the following situations:

• Term baby with no risk factor for excessive red cell breakdown.
• Jaundice appears after the first 48 hours of life and does not increase in severity.
• Healthy, active and feeding well.

 

What are the danger signs that I should be aware of?

You need to consult your doctor urgently in any of the following situations :

• Jaundice appears within the first 24 hours of life.
• Rapid progression of jaundice.
• If the result of the newborn screening shows G6PD deficiency.
• If previous babies in your family have severe neonatal jaundice.
• If your baby is unwell and not feeding satisfactorily.
• If there is presence of pale coloured stools or dark or tea-coloured  urine.
• Your baby is born preterm

 

What would the doctor do?

Your doctor will assess your baby clinically, proceed to do relevant investigations and then institute appropriate treatment. He will advise you on the specific situation of your baby.

 

What problems can jaundice cause?

• Acute Bilirubin Encephalopathy (ABE) – changes in behavior and muscle tone
• Kernicterus – lead to cerebral palsy and deafness and intellectual disability

Early intervention of babies at risk of severe jaundice will prevent this complication.

 

What are the ways to treat this condition?

There are two ways to bring down the bilirubin levels to avoid brain toxicity. These are:

• Phototherapy
• Exchange transfusion

Your baby will be put under a phototherapy light unit. The blue coloured component of the light can convert the bilirubin to a non-toxic product.

Newborn undergoing intensive phototherapy for severe neonatal jaundice.

 

Should not do: You should not expose your baby to sunlight for treatment due to risk of dehydration and sunburn

 

The toxic bilirubin level for term babies in the first week of life is usually taken as more than 20 mg/dL (340 umol/L). Exchange transfusion is used as a last resort to try to avoid brain toxicity due to severe neonatal jaundice. The levels for exchange transfusion will depend on many factors including the age of the baby and the cause of the jaundice.

 

Prevention

It is important to identify and monitor babies at risk of severe jaundice. Early detection of babies with jaundice needs to be done to ensure early and appropriate intervention.

 

What else can be done for babies who have suffered severe jaundice?

All babies with high bilirubin level (20 mg/dL or higher) should be followed up in a pediatric clinic to check on hearing and development. Some babies may need to be referred to the audiology department for a hearing test to exclude high tone deafness.

Brain damage due to severe jaundice (kernicterus} should be prevented. If it happens, the child should be referred to a multi-disciplinary team for rehabilitation.

 

Appendix

List of foods, medicines that should be avoided by people with G6PD deficiency:

• Food: mung beans
• Certain Chinese herbs
• Medications (consult your doctor for a complete list)
  • Antibiotics such as sulfamethozazole, nalidixic acid
• Chemical substance
  • Anti-moth (do not use on clothing)

 

Last reviewed	:	10 May 2024
Writer	:	Dato’ Dr. Jimmy Lee Kok Foo / Dr. Leow Poy Lee
Reviewer	:	Dr. Nurul’Ain binti Mat Kassim