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Baby Jaundice
The information in this feature explains jaundice in the newborn baby and what you should do if your baby's jaundice does not go away by two weeks of age for babies who are born on or around their due date (at term), or by three weeks for babies who are born early (prematurely). This information forms part of the Children's Liver Disease Foundation (CLDF) ‘Yellow Alert' campaign, which aims to raise parents' awareness of jaundice, which can indicate problems with your baby's liver, although this is rare.
Jaundice is the term used to describe the yellow appearance of the skin and the whites of the eyes. Jaundice is NOT a liver disease. It is very common in newborn babies, most of whom become jaundiced two or three days after they have been born. It can be more noticeable if your baby's birth was assisted using forceps or vacuum extraction (ventouse) and there is bruising where the ventouse cup or forceps blades were applied.
Jaundice tends to reach its peak when your baby is around four days old, then gradually disappears by two weeks postnatal. On rare occasions, jaundice can become apparent within the first 24 hours following birth; this tends to be when you are still in hospital. If there are concerns that your baby may be showing early signs of jaundice, the midwife will ask a neonatologist or paediatrician (doctors specialising in the care of babies and children) to see your baby.
What causes baby jaundice?
The human body continuously makes new red blood cells and breaks down the old ones. Newborn babies are born with a higher than normal number of red blood cells; these are broken down and the waste product from this process is the pigment ‘bilirubin' which is then removed from the body in the stools (poo) and urine. This is a job for the liver, but because even in mature babies the liver is still quite immature and in some babies, it cannot cope with the excess amount of red cells being broken down, the excess bilirubin is taken into the body's fatty cells. As it can take a few days after the birth before the liver can cope effectively, the bilirubin levels can build-up resulting in nine out of ten babies becoming jaundiced.
How can I tell if my baby has jaundice?
A quick test that new mums can do at home to check for jaundice is: in a ‘naturally' well-lit room, apply gentle pressure to your baby's chest. If there is a yellow tinge to the skin as this pressure is released, contact your midwife, health visitor or family doctor. This test works best for fair-skinned infants. For babies with darker skin tones, check for yellowness in the whites of the eyes or gums.
Can you measure the level of jaundice?
If your midwife or doctor is concerned that your baby is looking jaundiced, they will suggest that a simple test is done to measure the bilirubin level.
A small blood sample can be taken by pricking your baby's heel - this is sometimes called an "SB" (Serum Bilirubin) or a ‘bili' test. The test can identify whether the level of bilirubin in your baby's blood is getting higher, or whether your baby is already jaundiced. Alternatively, some maternity units may use a small light meter to help the midwives and doctors assess the extent of your baby's jaundice.
Can my baby's jaundice be treated?
In most cases, your baby's jaundice will have disappeared by around 14 days postnatal. Where the jaundice level becomes too high, there is a concern that this could damage your baby's brain and a small number of babies will require treatment to prevent this. The treatment commonly used is ‘phototherapy' and this is started before any harmful level is reached.
Phototherapy involves your baby being placed naked in a cot (this may be an incubator), which is then placed under a special blue (fluorescent-type) light that breaks down the bilirubin. Your baby does not need to be separated from you and the phototherapy unit can be placed over your baby's cot at your bedside. It is important that your baby's eyes are protected from the light, so the midwife will put on eye pads. Some maternity units prefer to use bili-blankets; in these cases, your baby will be wrapped in the bili-blanket which breaks down the bilirubin pigment. You will also be encouraged to feed your baby frequently, so that they produce plenty of urine, which helps to remove the excess bilirubin from their body. Phototherapy can usually be discontinued within a few days.
Where the jaundice is only mild, your midwife may suggest that you place your baby's cot in natural sunlight, which works in the same way. However, it is very important that you ensure your baby does not become overheated or sunburnt.
Why do some babies remain jaundiced longer?
There are a number of reasons why some babies remain jaundiced longer:
- the liver can take longer to work properly in babies born prematurely and jaundice can take three weeks to disappear
- healthy, breastfed babies can develop jaundice, called breast milk jaundice. This can take weeks to disappear, but is harmless. A simple urine or blood test can show whether the baby has breast milk jaundice or whether further tests need to be carried out in hospital
- some babies develop infections (eg urinary tract)
- there is a condition where the baby's red blood cells break down more quickly than usual. If this is suspected, your baby will be seen by a specialist doctor - a paediatric haematologist
- the baby's thyroid gland may not be working properly. This is tested as part of the blood (heel prick) test (Guthrie), which is done when your baby is between five and eight days old
- rarely, your baby may have a problem with their liver.
What else can I do?
You can check your baby's stools (poo) and urine. A newborn baby's urine should be colourless; however, if it is persistently yellow, whether or not your baby looks jaundiced, inform your midwife, health visitor or doctor. Similarly, babies stools are described as being green/daffodil yellow (where breastfed) and green/English mustard yellow (where bottle fed). However, if your baby's stools are a pale creamy/'chalky' colour, inform your midwife, health visitor or doctor.
If your baby is jaundiced for longer than two weeks, you should inform your health visitor or family doctor and ask them to do a simple test to see if the jaundice is ordinary baby jaundice, or whether it needs further investigation. In a very small number of cases, jaundice can be a sign that there is a problem with the baby's liver and it is important to get the baby checked. The Children's Liver Disease Foundation have developed a comprehensive information leaflet for parents and parents-to-be, entitled 'Jaundice in the new born baby'. The Foundation recommends that babies who are jaundiced for longer than two weeks postnatal should be tested, so that where liver disease is identified, it can be treated promptly. For further information about this topic and the ‘Yellow Alert' campaign visit their website at: www.childliverdisease.org or email: info@childliverdisease.org
Vicky Carne, MIDIRS 2009
News
New legislation supports working parents
Juggling parenthood alongside employment can be very challenging, with working parents having to balance the needs of their children and family against the expectations and responsibilities associated with their employment. Achieving a satisfactory work - family life balance can prove illusive and new parents often report feeling torn.
If this applies to you, you'll be delighted to hear that as from 6th April 2009, a change in the law now enables parents with children up to 16 years-of-age, to request flexible working hours from their employers. Parents who have been working for their employer in excess of six months, have the right to request flexible working conditions and their employers have a legal obligation to consider these requests favourably. Requests for flexible working hours can only be declined where the employer has good reason for this being impracticable.
Tighter safety in toys manufactured
Every parent loves watching their child's face light up as they are presented with a colourful new toy. While safety standards have been in place for some time, a new EU Directive adopted last month now gives added protection to children who play with toys that are made and sold within the European Union. This includes improved warning notices on packaging about age limitations for safe use, as well as more stringent rules regarding the chemicals and substances used in toy manufacturing.
Ultrasound scans in pregnancy
Parents-to-be can expect to find themselves facing a range of choices throughout pregnancy, including the preferred location for their baby's birth, who they want to be present (ie birth partners), as well as whether or not to have certain screening tests that are offered to the majority of pregnant women.
These screening tests are offered to determine a pregnant woman's chance of her pregnancy being affected by a range of conditions, most of which can be identified in the early stages of the baby's development. This means that the test is available to those where there is no awareness of a potential risk, or knowledge of being affected, as well as those who are already affected by a condition or complications, or who have known risk factors for these, eg cystic fibrosis.
An ultrasound scan is one such screening test and doctors and midwives use it to help assess the progress of a woman's pregnancy and to help identify whether there are any possible problems with her baby's development. However the significance of having an ultrasound scan and what it may pick up can often be easily overlooked. This is because expectant parents often view having a scan in early pregnancy, as a very exciting event, because it means they may be able to ‘see' their baby for the very first time.
It is however, up to you whether or not you choose to have a scan. Most pregnant women are offered one at about 12 weeks to accurately estimate their baby's due date - this is called a ‘dating scan'. These are mainly undertaken at your local maternity unit. However, in some areas of the country, the introduction of portable (hand-carried) ultrasound systems have enabled community-based midwife-sonographers (midwives specially trained in ultrasound scanning) to perform dating scans in the community setting. This initiative has proved very popular because women don't have to attend their local hospital and are scanned by the midwives providing their maternity care. No doubt similar initiatives will follow in other areas of the country!
You will also be offered a second scan at around 20 weeks of pregnancy. This scan is detailed and is used to check the appearance, growth and development of your baby. In order to help you decide whether or not you want to have an ultrasound scan, it is essential that you are given sufficient information about these tests so that you're able to make an informed choice. If you choose to have a scan and a potential problem is found, you may find that you and your partner have to make some difficult decisions. For this reason, it is important that you understand why scans are used in early pregnancy, what their limitations are, and what midwives and doctors can do with the information that they obtain from them.
Ultrasound scans make it possible to look ‘inside' the uterus (womb) and produce a picture of your baby on a computer screen and as a printed photo. The image of your baby is quite fuzzy, but the scan can be used to measure key parts of the baby to assess their development and growth, as well as to identify certain abnormalities. Screening tests can only give you information about something that might be present: it is not a test that can give you information that is 100% reliable. Because there is always some uncertainty about the results of screening tests, this means you might be told that there may be a problem when there is not or, the opposite, where you are told there is no problem, and it turns out that there is.
Ultrasounds are valuable as part of your antental care as they can provide reasonably accurate information on the following:
- a date for when your baby is likely to be full term (40 weeks). This is abbreviated to the EDD or EDC (expected date of delivery or confinement)
- whether you are carrying twins, triplets or more!
- the position of the placenta
- the position of your baby's heart and that it is beating normally (but not the identification of heart problems)
- problems with the bony structure of your baby, particularly the detection of an abnormality of the spine, called spina bifida, and for some abnormalities of the skull. For further information, also see the Informed Choice leaflet Is my baby alright? at: www.choicesforbirth.org
However, many other problems, including some congenital heart defects and all chromosomal and genetic abnormalities, such as Down's syndrome, cannot be accurately diagnosed with a scan and further tests are always necessary in order to make a firm diagnosis.
Ultrasound scans in pregnancy can help to identify problems with the baby's development. They can also offer you options about what action to take in the face of these problems, including planning surgery that may be required immediately following your baby's birth, as well as access to specialist counselling services which can help to reduce your anxiety by giving you more information about the condition. Some specific fetal abnormalities can even be treated while the baby is still inside your womb. Where a major birth abnormality is diagnosed, it can also help you decide whether or not to continue with the pregnancy. For more detailed information about having an ultrasound scan in pregnancy, see MIDIRS Informed Choice leaflet Ultrasound scans - what you need to know at: www.choicesforbirth.org.
Vitamin K
Deciding whether or not your newborn baby receives vitamin K is a choice that you and your partner will need to make soon after their birth. To help you reach a decision well in advance of this time, it is important that you have access to reliable information that you understand and which helps you to make an informed choice.
Vitamin K is a substance that is naturally present in the human body. It plays an important part in helping blood to clot. For example, if you cut yourself, vitamin K helps the blood to form a clot, which stops the bleeding and allows the skin to start healing.
At birth, a baby is born with very low stores of this vitamin and these are then quickly used up over the first few days of life. Once milk feeds are established the baby then gradually builds up its own stores. The initial low levels just after birth can leave a baby vulnerable to severe bleeding (haemorrhage) because they are less able to form blood clots. They can also develop a condition referred to as vitamin K deficiency bleeding (VKDB) which is a rare but very serious condition that affects 1 in 10,000 babies. Some babies are thought to be more at risk of developing VKDB. These include babies that are born early (prematurely), babies born by forceps or ventouse (vacuum extraction), where bruising can occur, and babies whose mothers have taken specific medication during pregnancy, especially the drugs used to treat epilepsy.
Since 1998 the Department of Health has recommended that vitamin K is given to all newborn babies as soon as possible after they have been born. This can be given by an injection in the top of your baby's leg, or as liquid medicine drops into their mouth (orally). The oral drops are usually given in three doses, two within the first week and then a third dose when the baby is one month old. Your midwife or doctor will give you information to read about vitamin K, which will include why it is being offered to your baby, and how it can be given. They will be able to answer any questions you might have. It is also important that you understand that although the Department of Health has made this recommendation, you have a choice as to whether or not your baby receives vitamin K and the route (oral or injection) used to give it.
Making up your mind
There are divided opinions about whether all babies should be given vitamin K as a routine treatment. The main opposition to the Department of Health recommendation centres on whether the baby should receive a ‘foreign' substance, which might have negative effects on the baby's future health, for a condition that is comparatively rare. This is probably one of the first decisions that you will need to make as new parents, so it is important that you are able to see the issues clearly and decide what is right for you and your newborn. For more detailed information see MIDIRS Informed Choice, Vitamin K for your baby at: www.choicesforbirth.org. Also talk to your midwife or GP, who will be able to help you with any questions or concerns you might have.
Will you lie down, stand up, sit or squat - or perhaps a mixture of all four? - Positions for labour
Every woman's labour is an individual, unrehearsed event, so you won't know for certain how you'll cope with your contractions and baby's birth. Similarly, no one knows for sure which position is best for you and your baby when you go into labour. Many women say they have an instinctive urge to stay upright and mobile, and adopt a certain range of positions which helps to relieve the pain of their contractions. However, some of the equipment used in hospitals will restrict your movements and can also affect your choice of position - for instance, the use of baby heart rate monitors, drips (intravenous infusions), and epidurals. All of these can mean that many women, while originally wishing to remain upright and mobile, often end up labouring on a bed, propped up with pillows instead of in a position of their choosing. For this reason, the midwives giving your care in labour will support you to make fully informed choices about their use.
Although the most common image of a woman in labour, frequently seen in the media and on television is for her to be lying on her back in a bed, research now shows that there are many benefits to remaining upright. These include:
- the use of gravity to help your baby move down the birth canal
- less risk of pressure on the major blood vessels that go to your womb (uterus) which, if compressed, reduce the oxygen supply to your baby
- your baby being more likely to be in a better position for passage through the pelvis
- stronger and more efficient contractions, which help your cervix to open up (dilate) more quickly and therefore, make your labour shorter.
The strongest influence however, in choosing your preferred position for labour and birth will be the environment in which you give birth to your baby. Giving birth at home will usually make it a lot easier for you to adopt a range of different positions by using familiar props around you for support. It's difficult to maintain an upright position in labour without some kind of support, either using aids (bar, ropes, ledges) or physical support from your birth partner or household furniture.
Where you are planning to give birth in your local maternity unit, birth centre or midwife led unit, there should be a range of items available that can help support you or make you feel more comfortable. These include comfortable chairs, rockers, birthing balls, a generous supply of pillows, beanbags, floor mattresses and furniture or wall bars of varying heights. If you want to give birth in hospital, it is helpful to find out what's available in the labour rooms, and whether the room is big enough to move around in. Being prepared before you go into labour will help you feel a lot more relaxed and in control. Similarly, if you have an interest in using a birthing pool, either for pain relief during labour or for the birth itself, please see the Informed Choice leaflet Do you want a waterbirth?
at: www.choicesforbirth.org. This leaflet provides more detailed information about this option and is helpful when discussing your choices with your midwife or doctor.
If you have any disability that might affect your ability to move about when you are in labour, or to communicate with the staff, it is a good idea to discuss this with your midwife, or contact the staff in the labour ward where you plan to give birth. This will mean that where extra support and props might be helpful, they can be obtained before you go into labour.
For more detailed information see Positions for labour and birth at: www.choicesforbirth.org. To find out more about your options, also talk to your midwife or doctor who will be able to help you with any questions you might have.
Registered office: 9 Elmdale Road, Clifton, Bristol. BS8 1SL. Email: support@choicesforbirth.org. Tel: 0800 581 009.
Terms & Conditions
The MIDIRS Informed Choice website is provided for reference information only. MIDIRS is not responsible or liable for any diagnosis made by a user based on the content of the website. Although great care is taken to ensure reference information is both suitable and accurate, MIDIRS is not liable for the contents of any external internet sites referenced, nor does it endorse any commercial product or service mentioned or advised on any of these sites.
