Jaundice

Around one in five newborn babies suffers from this temporary yellowing of the skin caused by the liver having to break down the excess of red blood cells that all babies have at birth. Jaundice can be associated with liver problems in older children too.

In newborns, a yellow pigment called bilirubin is produced when the excess blood cells are broken down and this gives the skin and sometimes the whites of the eyes a yellowy tinge. Apart from the yellowy skin, jaundiced babies are sleepy and reluctant to feed, so midwives encourage mums to wake them for feeds if necessary as producing more urine will help them clear the excess bilirubin from the blood via the liver.

Jaundice in newborns usually reaches its peak at about four days and then gradually disappears in most babies by the time they are two weeks old.

If jaundice is suspected in your baby, a serum bilirubin test will be done in which a small blood sample will be taken from his heel (known as the Guthrie or 'heel-prick' test) and the bilirubin level checked in the lab. If the result is high, your baby may need to spend some time under a phototherapy lamp in hospital as bright light helps to break down the excess bilirubin. Babies are placed in an incubator with just their nappy on to allow maximum exposure to the light and wear protective eyepads.

Persistent or prolonged newborn jaundice is defined as jaundice persisting beyond two weeks of age in a term baby and three weeks in a pre-term baby. It can be a sign of other complications such as hypothyroidism (an underactive thyroid gland) or liver disease.

Signs:

• Persistent yellow urine staining the nappy can be a sign of liver disease - urine in a healthy baby should be colourless.
• Persistent pale coloured stools may indicate liver disease - healthy coloured stools can be described as English mustard yellow in bottle fed babies and daffodil yellow in breast fed babies.

If complications are suspected, your baby will quickly be referred to a specialist for further tests. The blood test specifically used to identify liver disease is called a split bilirubin test which measures the direct and indirect bilirubin levels.

For more information about liver disease, contact the Children's Liver Disease Foundation.

What to do

• If your baby shows signs of jaundice after coming home from hospital, speak to your midwife who'll be visiting every day after the birth anyway.
• If mild jaundice is confirmed, feed your baby as often as possible to help him produce more urine and excrete the excess bilirubin in his bloodstream.
• Expose your baby to as much daylight as possible (but not direct sunlight as this could overheat or burn her skin easily).
• Newly born babies with persistently pale stools and / or yellow urine should be referred to a paediatrician immediately for investigation.