The most important thing first. Most newborn babies with jaundice have it mildly, it clears by itself and it needs no treatment at all. But in a small group the bilirubin level climbs too high, and the consequence then is permanent: according to CDC, high bilirubin can cause a form of brain damage called kernicterus, which happens when severe jaundice is left too long without treatment. Which means that small group is preventable.
Recognising it: where to look, and how
A newborn's skin is naturally pink or slightly red, so a yellow tinge is hard to see. According to NHS, pressing gently on the bridge of the baby's nose or the forehead and looking the moment you lift your finger makes the yellow clearer, and the yellow is easier to see in good light. Look at the whites of the eyes too, the palms and soles, the inside of the cheeks and under the tongue. According to CDC, jaundice is harder to see in babies with darker skin — do not conclude “no yellow” on the strength of one look in a dim room.
- THE ORDER IT SPREADS: according to CDC, jaundice appears on the face first, then moves to the chest, the abdomen, the arms and the legs as the bilirubin level rises. Yellow that has reached the palms and soles means there is more of it, and that is not a small matter.
- According to NHS, the yellow is usually at its most obvious when the baby is around three days old, and it usually takes about two weeks to clear.
- Three things worth watching more closely than the colour: whether the baby is ALERT, how the baby is FEEDING, and whether the wet and dirty NAPPIES are keeping up with the previous few days.
- Deepening by the day instead of fading, or still rising after being seen, is a reason to phone the doctor back rather than a reason to wait longer.
Easily confused: two signs quite unlike ordinary jaundice
- JAUNDICE WITHIN THE FIRST DAY AFTER BIRTH. According to NHS, a baby less than one day old who is jaundiced is an emergency, not a wait-and-see.
- PALE STOOLS together with dark yellow or brown urine. According to NHS, this is a reason to ask for an urgent appointment. It points towards disease of the liver and the bile ducts rather than ordinary jaundice, and finding it early changes the outcome.
What to do straight away
- Look at the skin colour every day in natural light, with some of the clothing off.
- Feed enough and feed often. According to CDC, most newborns with jaundice can carry on breastfeeding, and feeding more frequently also helps the mother's milk come in; feeding well is how the baby's body clears bilirubin.
- Count the nappies: write down the number of wet nappies and the number of stools each day. Markedly fewer than the previous few days is a sign the baby is not feeding enough.
- Keep the postnatal check appointment. According to CDC, every baby should be checked by a nurse or a doctor at three to five days old, because that is usually when bilirubin is at its highest.
- Write it down by the baby's age in days: how far the yellow goes today, how feeding and nappies are going. Take the baby's health record with you when you are seen, and say clearly whether the baby was preterm or full term.
What you must NOT do
- DO NOT PUT THE BABY IN THE SUN. According to CDC, a baby should not be placed in direct sunlight: it is not a safe way to treat jaundice and it can give the baby sunburn. Outdoor sunlight is no substitute for phototherapy — according to CDC, the treatment is undressing the baby and placing them under special lights.
- DO NOT confuse two different things: looking at the skin colour in good light is for RECOGNISING, putting the baby in the sun is meant as TREATING. The first is worth doing, the second is not.
- DO NOT stop breastfeeding on the belief that breast milk causes jaundice. Stopping means the baby takes in less and usually makes the jaundice worse. There are cases where a doctor advises stopping for a time, but that is the doctor's instruction.
- DO NOT give a newborn water, sugar water or herbal infusions to “flush out the yellow”. A baby needs milk; those things only mean the baby drinks less milk.
- DO NOT buy medicines, herbal remedies or digestive supplements for a newborn because of jaundice.
- DO NOT wait for it to “clear in a few days” once any of the signs in the box below are present. If the colour is fading while the baby is drowsy and feeding poorly, look at the baby, not at the colour.
When you must go to hospital
GO TO EMERGENCY CARE or call 115 (the emergency number in Vietnam) NOW — do not wait until morning — if a jaundiced baby has ANY of the following; according to CDC and NHS this group of signs belongs at emergency level: the jaundice appeared within the first day after birth; sleeping more than usual, hard to rouse, not waking however much you call; unable to feed or refusing to feed; a high-pitched shrill cry that cannot be settled; the body stiffly arched backwards like a bow, or floppy; eyes rolling or looking in an unusual direction; jerking or fits; a fever, or being unusually cold; not one wet nappy from morning right through to night; laboured or grunting breathing, or the belly pulling in under the ribs with each breath. — BE SEEN THE SAME DAY, do not wait until tomorrow, if: the baby is deeply yellow or orange, or the yellow has reached the palms and soles; unusually severe fretfulness; feeding markedly less well; fewer wet and dirty nappies than the previous few days; pale stools together with dark yellow or brown urine; the jaundice is not fading, or is deepening, after being seen; the jaundice is still there after two weeks. — If you are unsure, phone and ask before deciding for yourself.
Newborn jaundice is measured and treated at a medical facility: the bilirubin level only comes from a test. It cannot be measured or treated at home instead. What Y Te Xanh does is something else: a remote consultation so you can decide whether to go now or wait for the appointment, and a doctor coming to the house to take the history, examine, and say clearly which cases must be admitted. We are not a substitute for the baby's newborn check. With a sign from the box above, go in first and call afterwards.
The signs, the risk groups and the warning about sunlight above follow the public material of CDC in the United States on jaundice and kernicterus. How to look for the yellow, the three-day mark and the pale-stool sign follow NHS. This article passes that on and does not replace being examined. Citing CDC here does not imply that CDC endorses Y Te Xanh or our services.
Need personalised advice for your loved one? Call our hotline 094 368 81 15 (24/7) — calling to ask a question or to book costs nothing. GreenCare has doctors who come to examine, nurses who carry out doctor's orders (injections, infusions, dressing changes), remote consultation by video call, and a review of the medicines you are taking; an in-depth remote consultation, or any one after the first, is a paid service. For children we take examination and acute care only — not long-term care at home, and not newborns or expectant mothers. We confirm we have staff in your area and provide transparent pricing before we begin.
Sources
- NHS — Jaundice in babies
