You may have noticed that your baby’s skin and the whites of their eyes were a bit yellow in the days after they were born. That yellow colour is caused by a waste product in the blood called bilirubin.
Normally, our liver changes bilirubin into waste that our body can easily get rid of when we go to the toilet. But a newborn baby’s liver can take a while to get used to doing this. As a result, the bilirubin builds up in Baby’s blood, and it shows up as a yellow tinge in the skin.
A baby’s jaundice level can be easily checked by the midwife or nurse. The best way to check to see if a baby needs treatment for jaundice is to measure the amount of bilirubin in Baby’s body. The first time we test for this is with a small handheld instrument that uses light to measure the bilirubin level in the skin.It’s an instant and very easy test, and is painless. If this test suggests a high level of bilirubin, then we’ll need to take a blood sample. Using a very small needle, we take a few drops of blood from Baby’s heel. This blood test is a more exact way to know if your baby needs treatment.
Treatment is very easy and safe. It all happens using blue light from a special blanket that you wrap your baby in. The treatment is called phototherapy. ‘Photo’ means light, so ‘phototherapy’ is light therapy. The blue light shines through Baby’s skin. This changes the bilirubin into a form that Baby can get rid of more easily.
We’d like you and your baby to be home together as soon as you’re ready, but there are a few boxes to tick to make sure that your baby can have phototherapy at home.
Here’s the list:
- Your baby must be close to full term
- They must be at least 48 hours old
- Other than having jaundice, your baby must be medically well, and will be checked by the baby doctor to ensure they are suitable for phototherapy at home.
- You will need to speak to a nurse from the Hospital in the Home team
- And finally, you’ll need to have a feeding plan in place for your baby. We’ll talk with you about this.
Important contacts
If you cannot get in contact with your visiting nurse or midwife, you can get advice from:
- The Maternal and Child Health Line on 132 229 available 24 hours a day throughout Victoria
- Nurse on Call on 1300 60 60 24 for advice
If there is an Emergency, please call 000
The Women’s does not accept any liability to any person for the information or advice (or use of such information or advice) which is provided on the Website or incorporated into it by reference. The Women’s provide this information on the understanding that all persons accessing it take responsibility for assessing its relevance and accuracy. Women are encouraged to discuss their health needs with a health practitioner. If you have concerns about your health, you should seek advice from your health care provider or if you require urgent care you should go to the nearest Emergency Dept.
Jaundice (JOHN-diss) is also called hyperbilirubinemia (HI-per-bil-ee-roo-bin-EE-mee-ah). It means that there is a high level of bilirubin (BIL-ee-rue-bin) in the blood. This is a yellow pigment that settles in body tissues and can make your baby’s skin look yellow. Jaundice often happens in newborns. It is usually seen on the second or third day of life and goes away by the second week after birth. The jaundice does not usually cause any lasting effects, but if levels are high and left untreated it can cause serious problems.
The Cause of Jaundice
When red blood cells in the body break down, a yellow pigment called bilirubin is formed. Usually the liver is able to break down the bilirubin so it can leave the body in the urine and stool (bowel movements). Sometimes, especially in newborn babies who are premature, the liver is not developed enough to break down the bilirubin. As the bilirubin goes into the body tissue, the skin, gums and whites of the eyes will appear yellow (jaundice). With time and treatment the baby's color returns to normal.
Treatment
Infants are treated with a special kind of light, called a bili-light.
- Your baby will be placed in a bed with bili-lights. The lights shine on the baby’s skin and change the bilirubin. It can then pass out of the body through the urine and stool.
- Your baby will need to be under the light for about 1 to 2 days.
- He may also lie on a blanket of light, called a bili-blanket.
- He will stay under the bili-light as much as possible. During this time, his eyes will be covered with patches because the light can damage them. The patches can be taken off when your baby is not under the light, such as when he is being fed or bathed.
- While your baby is in the hospital, tiny drops of blood will be drawn from the baby’s heel from 1 to 4 times per day. This is to measure the amount of bilirubin in the blood.
- Your baby may have an IV (intravenous) line to deliver fluids into his body to make sure he stays hydrated.
- Feeding your infant every 2 to 3 hours helps move the bilirubin through the body so it can be passed out of his body through stool.
What You Can Do
This is an important time for you to get to know your baby (Picture 1). We encourage you to help with your baby's care, including feeding and changing his diapers. This will help you and your baby get to know each other.
If you are breastfeeding, please keep breastfeeding. your infant directly and pump as needed. Direct breastfeeding your infant as much as possible helps to establish your milk supply. It also helps your baby to learn how to breastfeed successfully.
This may also be a hard time for you, so let us know how we can help. We understand that the hospital may be new to you. Please ask us any questions you may have.
What to Expect
Remember jaundice is usually temporary and will go away in time. Once your baby is placed under the bili lights, it is important to leave him under the lights between feedings to maximize the light therapy and bring down the bilirubin level quickly. The nursing staff will try to cluster vital signs, lab draws, and diaper changes around your baby’s feeding time so your baby can be under the bili light as long as possible. Ongoing breastfeeding is strongly encouraged and supported.
Sometimes during the first few hours of phototherapy, your baby may need to be given a bottle of your expressed breast milk or formula. This is so we can be sure he is getting enough fluids and the right nutrition, which also brings down the bilirubin level faster. Breast pumps and kits are available if needed.
To keep the baby taking in enough milk by direct breastfeeding is the ultimate goal. After your baby's bilirubin level has gone down (usually below 14) and the bili-light is turned off, he will be discharged as long as he has no other complications that require a longer hospital stay. Your doctor may want to check the bilirubin level again after your child goes home from the hospital.
If you have any questions, be sure to ask your nurse or doctor.
Jaundice (Hyperbilirubinemia) (PDF)
HH-I-137 9/90, Revised 8/17 Copyright 1990, Nationwide Children's Hospital
Speak to your midwife, health visitor or GP if your baby develops jaundice. They'll be able to assess whether treatment is needed. Treatment is usually only needed if your baby has high levels of a substance called bilirubin in their blood, so tests need to be carried out to check this. See diagnosing jaundice in babies for more information about the tests used. Most babies with jaundice do not need treatment because the level of bilirubin in their blood is found to be low. In these cases, the condition usually gets better within 10 to 14 days and will not cause any harm to your baby. If treatment is not needed, you should continue to breastfeed or bottle feed your baby regularly, waking them up for feeds if necessary. If your baby's condition gets worse or does not disappear after 2 weeks, contact your midwife, health visitor or GP.
Newborn jaundice can last longer than 2 weeks if your baby was born prematurely or is solely breastfed. It usually improves without treatment.
But further tests may be recommended if the condition lasts this long, to check for any underlying health problems.
If your baby's jaundice does not improve over time, or tests show high levels of bilirubin in their blood, they may be admitted to hospital and treated with phototherapy or an exchange transfusion.
These treatments are recommended to reduce the risk of a rare but serious complication of newborn jaundice called kernicterus, which can cause brain damage.
Phototherapy is treatment with a special type of light (not sunlight).
It's sometimes used to treat newborn jaundice by making it easier for your baby's liver to break down and remove the bilirubin from your baby's blood.
Phototherapy aims to expose your baby's skin to as much light as possible.
Your baby will be placed under a light either in a cot or incubator with their eyes covered.
It will usually be stopped for 30 minutes so you can feed your baby, change their nappy and give them a cuddle.
If your baby's jaundice does not improve, intensified phototherapy may be offered.
This involves increasing the amount of light used or using another source of light, such as a light blanket, at the same time.
Treatment cannot be stopped for breaks during intensified phototherapy, so you will not be able to breastfeed or hold your baby. But you can give your baby expressed milk.
During phototherapy, you baby's temperature will be monitored to make sure they're not getting too hot, and they'll be checked for signs of dehydration.
Intravenous fluids may be needed if your baby is becoming dehydrated and they are not able to drink enough.
The bilirubin levels will be tested every 4 to 6 hours after phototherapy has started, to check if the treatment is working.
Once your baby's bilirubin levels have stabilised or started to fall, they will be checked every 6 to 12 hours.
Phototherapy will be stopped when the bilirubin levels fall to a safe level, which usually takes a day or two.
Phototherapy is generally very effective for newborn jaundice and has few side effects.
If your baby has a very high level of bilirubin in their blood or phototherapy has not been effective, they may need a complete blood transfusion, known as an exchange transfusion.
During an exchange transfusion, your baby's blood will be removed through a thin plastic tube placed in blood vessels in their umbilical cord, arms or legs.
The blood is replaced with blood from a suitable matching donor (someone with the same blood group).
As the new blood will not contain bilirubin, the overall level of bilirubin in your baby's blood will fall quickly.
Your baby will be closely monitored throughout the transfusion process, which can take several hours to complete. Any problems that may arise, such as bleeding, will be treated.
Your baby's blood will be tested within 2 hours of treatment to check if it's been successful.
If the level of bilirubin in your baby's blood remains high, the procedure may need to be repeated.
If jaundice is caused by an underlying health problem, such as an infection, this usually needs to be treated.
If the jaundice is caused by rhesus disease (when the mother has rhesus-negative blood and the baby has rhesus-positive blood), intravenous immunoglobulin (IVIG) may be used.
IVIG is usually only used if phototherapy alone has not worked and the level of bilirubin in the blood is continuing to rise.
Page last reviewed: 03 February 2022
Next review due: 03 February 2025