Medicines for Newborn jaundice

What it is

Newborn (neonatal) jaundice is a yellowing of a baby’s skin and the whites of the eyes, and it is very common in the first days after birth, affecting a large proportion of newborns. It is caused by a build-up of a substance called bilirubin in the blood — bilirubin is produced normally when red blood cells break down, and in newborns it can build up because a baby’s liver is still maturing and is not yet fully efficient at removing it. This common form usually appears around the second to fourth day of life, and in most babies it is harmless and clears on its own within a couple of weeks as the baby’s liver matures, without any treatment. It is often more noticeable in the face first, then spreading. Although most jaundice is normal and harmless, it is important that newborn jaundice is checked, because in some cases the bilirubin level rises high enough to need treatment, and because jaundice can occasionally be a sign of an underlying problem. Certain features raise concern and need prompt assessment: jaundice appearing very early (within the first 24 hours of life), a baby who is very yellow or becoming more yellow, jaundice lasting longer than about two weeks, a baby who is unwell, feeding poorly, or very sleepy and difficult to wake, or pale stools and dark urine. Newborn babies are checked for jaundice as part of routine care, and any concerns are followed up.

How it is treated

Most newborn jaundice needs no treatment beyond monitoring and ensuring the baby feeds well, as it resolves on its own as the liver matures. Ensuring the baby is feeding regularly and well (whether breast or bottle feeding) helps, as good feeding supports the baby in clearing bilirubin; a midwife or health visitor can help with feeding and will monitor the jaundice. When jaundice is more pronounced, the bilirubin level is measured (with a skin device or a blood test), and this guides whether treatment is needed. If the level is high enough, treatment is given, most commonly phototherapy — light therapy in which the baby is placed under a special light that helps break down the bilirubin so it can be removed; this is safe and usually effective, and the baby continues to feed. In more severe cases, or when jaundice is due to certain underlying causes, other treatments may be needed, and investigations are carried out to identify any underlying cause (for example if jaundice appears very early or lasts a long time). The key messages for parents are to make sure the baby feeds well, to attend newborn checks, and to seek prompt advice if the baby becomes more yellow, is jaundiced in the first 24 hours or beyond about two weeks, is feeding poorly, is very sleepy or unwell, or has pale stools and dark urine. The reassuring message is that newborn jaundice is very common and usually harmless and settles on its own, that it is routinely checked, and that effective treatment (usually phototherapy) is available for the cases that need it.