What is jaundice 

"Our eyes disclose what mouths cannot"

My baby girl had big wide eyes, from day one they seemed like they would be fixed onto you, as if she was making eye contact (which would be crazy as newborns can't see well), nevertheless she was very alert for a newborn. After a few days, I noticed these big wide eyes began to look discoloured, they had a yellow tinge. For me, this was the only "abnormal" sign there was, she was not overly tired or having feeding issues, she was my perfectly alert baby. As a light skinned black women, my undertones are yellow myself, I cannot tell you how many times someone has pointed this out to me, so her skin looked completely normal and just like her mummy's. It was not the clearly bright yellow eyes and skin I had seen from other patients during nursing, but my baby had jaundice.  

It can be startling to notice that your baby’s skin or eyes appear yellow just a few days after birth. While it can look concerning, it’s very common and usually harmless. This is known as newborn jaundice and it’s important for parents to understand what causes jaundice, how to recognise it, and when to seek medical attention.

The physiology of jaundice 

When red blood cells break down, there is a buildup of a substance called bilirubin in a baby’s blood. The condition occurs because babies have more red blood cells at birth, and these cells break down quickly after delivery. Furthermore, though delayed cord clamping has numerous benefits, the extra blood passing to the baby can increase the change of jaundice. Bilirubin has a yellow pigment and normally, the liver helps remove bilirubin from the body, but in newborns, the liver is still developing and takes time to work efficiently. As a result, bilirubin can accumulate in the bloodstream, causing the skin and eyes to turn yellow.  

Jaundice is extremely common among newborns, affecting about 60% of full-term babies and up to 80% of those born prematurely. Certain factors, such as feeding problems or dehydration in breastfed babies, can also contribute to jaundice. In some cases, a difference between the mother’s and baby’s blood types — such as Rh or ABO incompatibility — can cause the baby’s red blood cells to break down more rapidly, resulting pronounced jaundice. There is also evidence that G6PD deficiency can cause jaundice, especially in newborns, because the enzyme is critical for protecting red blood cells from damage, which is important to consider if you and/or your partner is a carrier. 

What can I do?

As a parent, you are you babies best advocate. Despite my professional background, I did not feel ready for this role. In my opinion, the best way to get ready for this role is to get informed and get comfortable with raising any concerns you might have, nothing is too silly if it ends up saving a life. Look out for these signs and if you have any concerns let them be known! 

Parents can usually recognize jaundice by: 

• the yellowing of the baby’s skin and the whites of the eyes. 

• Often begins on the face and then spreads to the chest, abdomen, arms, and legs.

•  Some babies seem unusually sleepy, 

• Difficulty feeding

• Produce dark urine and pale-colored stools. 

A simple way to check for jaundice at home is to gently press a finger on the baby’s forehead or nose; if the skin looks yellow when you release it, it’s a good idea to let your midwife or doctor know. They can check the actual levels in the blood through a small heel prick test, with some using a non-invasive transcutaneous bilirubin (TcB) device over the skin, though this method is less accurate. Often jaundice levels are low enough to not need treatment. At home to help the bilirubin pass through the system you ensure feeding is going well, if you are having any difficulties make sure you get the support you need and discuss this with a professional. You can also expose your baby to small amounts of sunlight by sitting near windows or going to short walks, please no prolonged unsafe exposure in the boiling heat though.  

Only around 1 in 20 babies has a blood bilirubin level high enough to need treatment. The most common form of treatment, if needed, is phototherapy. Often a blue light is placed over baby and used to alter the bilirubin through the skin into a form that can be more easily broken down by the liver. With a little mask placed over baby's eyes, seeing your baby like this can be upsetting but baby will be monitored and if you talk to them it can be reassuring and offer some comfort for you both. 

So the take away is that newborn jaundice is common and often goes away on it's own or with a little extra light? So no need to worry? I don't need to think about it? Unfortunately there are instances were jaundice is more serious. 

Pathological jaundice typically appears within the first 24 hours of life and may be caused by infections, blood group incompatibilities, or liver problems. This form requires immediate medical attention. The good news is, most people are typically within the hospital during this time and medical professionals are likely to spot this; however, realistically this may not always be the case. Early discharges can mean this could be missed and sometimes more experienced mothers can sometimes be left to their own devices, especially if staffing is short or demand is high. If the parent is seen as confident and content, then sometimes staff may not be as alert to the rising problem. This sad reality means it is important you are able to recognise if there is any concerns and feel confident to advocate for you and your baby. If you notice any of the symptoms mentioned above within the first 24 hours, even if its only mild or your not entirely sure, raise your concerns. Sounds scary, after all most people coming into hospital aren't medical professionals you might feel like "what do I know?" and after today hopefully the answer to that question will be: "I know how to recognise jaundice/ recognise when my baby is acting different". 

Ok so my baby has jaundice after 24 hours, we're out of the woods, no need to worry? 
-Sorry but also no. It can be common, it can be nothing to worry about but it can be very serious if it goes untreated and doesn't get better. Think kernicterus. 

Never heard of kernicterus? Don't worry neither had I and to most reading you will never hear or need to worry about it, but my aim is to let you know what to look out for to avoid this. Kernicterus is... eventually leading long term to seizures. 

Initial symptoms of kernicterus in babies include:

• poor feeding

• irritability

• a high-pitched cry

• no startle reflex

• lethargy (sleepiness)

• brief pauses in breathing (apnoea)

• their muscles becoming unusually floppy, like a rag doll

Notice these signs? Seek immediate help. 

I know this has been a lot to take in but honestly, newborn jaundice is usually temporary and completely treatable. With regular feeding, careful monitoring, and early medical attention when needed, most babies recover fully within a couple of weeks. I hope this post has helped. You've got this! 💕