Newborn Jaundice: When Is It Normal and When Is It Urgent?

When a baby’s eyes begin to look yellow a few days after the birth, the first question in a parent’s mind is “is this normal?”. Usually the answer is yes: newborn jaundice appears as the bilirubin level in the blood rises and then settles as the baby feeds well. The course is not the same in every baby: the time of onset, how the baby feeds and the risk factors tell you how the picture should be read.

Below I look at when newborn jaundice is physiological, which situations carry risk, which signs mean you should see a doctor without waiting, and what can be done at home. Nothing here is a diagnosis; the assessment belongs to the doctor.

How jaundice comes about

Every cell in the body wears out and breaks down. As red blood cells break down, the haemoglobin inside them turns into the yellow pigment called bilirubin, which the liver processes and passes into the bowel through the bile.

In the newborn period this system has not matured: the liver has a limited capacity and a baby who does not feed well clears bilirubin more slowly. Jaundice is not a disease but the visible face of a process under way; the question is whether it stays within the expected limits.

When is it considered “normal”?

Jaundice is read by looking at the time of onset, the rate of rise, the duration and the baby’s risk status together; no single observation is enough. Jaundice within the first twenty-four hours of birth is not physiological: it needs to be measured and the cause investigated. A picture that begins in the first days, settles as the baby feeds regularly, and where alertness, feeding and colour remain normal is followed up with observation.

Two separate pictures are linked with breastfeeding. One follows from insufficient milk intake in the first days and usually settles within the first week. Breast milk jaundice is the other: it may last longer even though feeding continues, and a doctor follows it up.

What makes jaundice risky?

As Dr. Murat Palabıyık notes in his writing on doktoramcam.com, the risk groups include blood group incompatibility between mother and baby, prematurity, trauma during delivery and infection.

• Prematurity: the liver’s capacity is more limited and weight is gained more slowly.
• Injury during birth: bruising and pressure marks increase the breakdown of red blood cells.
• Blood group incompatibility between mother and baby: antibodies passed from the mother can affect the baby’s blood cells.
• Infection: an infection in the baby or in the mother changes the picture.
• Insufficient milk intake: bilirubin clearance is delayed and jaundice may last longer.

The course of jaundice is tied to how often the baby feeds, and the birth weight with the length of the pregnancy affect how the follow-up interval is planned, which is why the checks look at all three together.

Warning signs that come with jaundice

Jaundice on its own is not a reason for alarm if the baby seems well. The picture changes when other signs appear alongside it. If a jaundiced baby shows any of the following, call 112 or go to the nearest emergency department immediately:

• The baby is difficult to rouse, looks very drowsy or floppy
• The baby stops feeding or cannot take the breast
• Crying is sharper or higher-pitched than usual, the head or body arches back, or there are seizures
• Bluish colouring or cold sweating

If the baby develops a temperature, see a doctor or go to an emergency department without delay.

In the following situations you should see a doctor the same day:

• Feeding is clearly difficult, the baby looks pale, or feeds become short
• Urine output falls, or the nappies are less wet than expected
• The stool is pale cream, chalky white or clay-coloured
• The colour spreads to the body and limbs, or clearly increases over several days

If you are not sure whether something is urgent, see a doctor or go to an emergency department rather than wait; the decision belongs to the doctor.

How jaundice is assessed

The first step is to measure the bilirubin level, with a small device applied to the baby’s skin or with blood taken from the heel; which method is used and how the result is read are decisions for the doctor. Where necessary, blood group compatibility and blood cell tests are carried out too.

The measurement is not a diagnosis but the basis for a follow-up decision. The value is read against the birth weight, the length of the pregnancy, the hour of the measurement and the course of the jaundice, so “is this value all right?” cannot be answered at home. The Hipokrat TV programme “YENİDOĞAN SARILIĞI” deals with the warning signs and with how follow-up is approached. In more serious cases options such as phototherapy or exchange transfusion may come up, and the doctor decides.

What you can do at home

What you can do at home is not to assess the baby but to carry the right information to the doctor. Taking the baby into good light to observe the colour of eyes and skin, noting the colour of urine and stool, recording how often the baby feeds and watching alertness are valuable steps.

The colour of urine and stool is a practical indicator of progress. Plenty of pale urine and normally coloured stool usually show that the baby is feeding well and bilirubin is still being cleared; a stool that turns pale cream, chalky white or clay-coloured, or urine that clearly darkens, should be reported to the doctor the same day.

Keeping up the frequency of feeding is the step at home that influences the course of jaundice most: making sure the baby can empty the breast, and offering both breasts rather than always the same one. A drop in feeding frequency or in milk supply is a change the doctor needs to hear about. Giving water or sugary liquids without asking the doctor does not make jaundice resolve faster.

Common mistakes

• Postponing the appointment because “it will pass in a few days”: the follow-up interval is set by the doctor, and a missed check cannot be made up.
• Judging the colour by eye: a bright room and daylight give different impressions, and looking does not replace a measurement.
• Waiting in the sun: the sun may reduce the colour for a while, which does not mean the picture has settled.
• Reducing breastfeeding because it is difficult: a fall in milk intake can worsen the picture, and a reduction is discussed with the doctor first.

In brief

• Newborn jaundice is normal for most babies, but the “normal” decision comes from a measurement, not from looking.
• Jaundice starting within the first twenty-four hours is not physiological and needs assessment.
• Risk groups include blood group incompatibility, prematurity, birth trauma and infection.
• If a jaundiced baby is hard to rouse, stops feeding, cries in a high-pitched way or has seizures, call 112 or go to the nearest emergency department immediately.
• A bilirubin measurement is not a diagnosis but the basis of a follow-up decision.
• Continuing to feed, watching urine and stool colour and following the plan are the steps not to skip.

Newborn jaundice is a smooth process for most babies when it is followed properly, but in some patterns moving quickly makes a difference. To have the jaundice, weight and feeding of your baby assessed together, you can book at our practice in Florya or call us on 0212 599 11 16.