Jaundice before 24 hours of life is considered ‘pathological’, is usually caused by haemolysis (break down of red blood cells), and needs further evaluation.
Jaundice occurring after 24 hours of life is referred as ‘physiological jaundice’. It’s not uncommon for most of the babies to have mild jaundice which does not require any interventions. However, if the jaundice levels are above a threshold then we may require interventions in the form of optimising the fluid intake to flush the jaundice and phototherapy. Babies who have bleed in their scalp from instrumental delivery and babies with incompatibility between baby’s and mother’s blood group are predisposed to more severe jaundice.
How do we assess the level of jaundice – The severity of jaundice can be roughly estimated by looking at baby’s skin colour on different body parts. Jaundice usually starts on the face and gradually travels to the feet. Hence, jaundice below the knees is considered to be severe. Also, it is important to remember that jaundice makes babies sleepy and if a baby is not often waking up by themselves for feed 3-4 hours post last feed then this is considered ‘symptomatic’. It can be a vicious cycle, as jaundice makes babies sleepy, sleepy babies don’t feed much, less feeding reduces the fluid levels in their body. This would lead to more jaundice and in turn make them more sleepy. Hence, it is advisable to ensure that your baby is feeding every 3-4 hourly, especially if their looking jaundiced. Usually, we start by doing a ‘skin jaundice test’ which is called as ‘TCB’ which stands for Transcutaneous Bilirubin. TCB only gives an estimate of jaundice levels and if it is above a threshold then we do blood jaundice test (SBR). If the latter is above threshold then we consider phototherapy. We usually repeat the SBR before ceasing the phototherapy to confirm that the jaundice levels are back to non-concerning range.
How do we treat jaundice – we ensure that babies receive good amount of fluid intake either with regular breast feeding or by toping up with formula feeds after every breast feed. We put babies under special blue lights called ‘Phototherapy’ usually for at least 12-24 hours or overnight, and recheck their blood jaundice levels the next morning. Depending on their blood jaundice levels, we then decide whether to cease or continue with phototherapy. At times, we may consider repeating the blood jaundice test 12-24 hours after ceasing phototherapy to check for rebound. Also, note that babies receiving phototherapy require more fluid intake due to higher water loss through skin.