Prolonged jaundice

What is jaundice?

Jaundice is a medical term for when a persons skin or the whites of their eyes have a yellow appearance. Yellowing of the skin can be more difficult to see in brown or black skin. Jaundice in newborn babies is common and is usually harmless. The medical term for jaundice in babies is neonatal jaundice.

In babies that are born at full-term (after 37 weeks of pregnancy), it is estimated that 6 out of every 10 develop jaundice. Jaundice is more common in babies that are born premature with around 8 out of 10 developing jaundice.

The symptoms of newborn jaundice usually develop 2 days after the birth and tend to get better without treatment by the time the baby is about 2 weeks old.

What is prolonged jaundice?

Prolonged jaundice is when the yellowness of your babies skin or whites of the eyes has not completely faded by 2 weeks of age in a full-term baby, and after 3 weeks in a premature baby. Prolonged jaundice is usually harmless, but can rarely be a sign of a serious liver problem.

What are the symptoms of jaundice and prolonged jaundice?

The main symptom of jaundice is yellowing of the babies skin or whites of their eyes. This can be more difficult the see in babies with brown or black skin.

Most babies with jaundice do not have symptoms but may also have:

• be more sleepy and not waking for feeds
• poor feeding
• having dark wee which should be colourless
• having pale poos which it should be yellow or orange

What causes jaundice?

Jaundice is caused by having too much of something called ‘bilirubin’ in the blood. Bilirubin is a yellow substance that is produced when red blood cells are broken down. Bilirubin travels in the blood stream and is transported to the liver where it is altered so that it can be passed out of the body in the poo. Jaundice happens when their is excess bilirubin and the liver cannot get rid of it.

Jaundice is common in newborn babies because they have a higher number of red blood cells in their blood that are broken down and replaced frequently. A newborn baby’s liver is not fully developed, so it is less effective at processing the bilirubin and removing it from the blood.

What causes prolonged jaundice?

Prolonged jaundice can be caused by:

• an infection or illness
• a condition where the babies red blood cells are being broken down faster than normal. This is usually recognised during pregnancy or shortly after birth
• a problem with your babies thyroid gland
• a liver problem, but this is rare
• a metabolic problem, but this is rare

Babies who are breastfed often stay jaundiced for longer than bottle fed babies. If this is the case, breastfeeding should continue and the jaundice will fade.

How is prolonged jaundice diagnosed?

Babies that are thought to have yellowing of the skin or eyes are referred to the prolonged jaundice clinic by either your midwife, health visitor or GP. In the prolonged jaundice clinic you will be seen by a clinician that will investigate the cause of their prolonged jaundice.

They will ask you questions about:

• your pregnancy, your babies birth and how your baby is fed
• the colour of your babies poo and wee
• if there are any related conditions within your family history

The phlebotomy team will also do blood tests on your baby to check for:

• infection
• thyroid problems
• liver problems
• metabolic problems

What happens after prolonged jaundice clinic?

The results will be reviewed by the clinician. If these are all normal a letter will be sent to your GP.

If the results are not normal, the clinician will contact you and inform you of the next step that need to be taken. This could be more blood tests, an ultrasound or treatment.

If your baby is discharged from prolonged jaundice clinic and is still jaundice by 6 weeks of age, take them to the GP who can review your baby and refer if needed.

How is prolonged jaundice treated?

The treatment for prolonged jaundice depends on the cause. Breastfeeding is often a cause of prolonged jaundice, this does not require treatment and will disappear with time.

If there is a liver or thyroid problem causing prolonged jaundice, your baby will need to see a specialist for treatment.