Jaundice in newborns - Treating jaundice in newborn babies

You should speak to your midwife, health visitor or GP if your baby develops jaundice. They will be able to assess whether treatment is needed.

Treatment is usually only necessary if your baby has high levels of a substance called bilirubin in their blood, so tests will 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 will usually get better within 10-14 days and won't cause any harm to your baby.

If treatment is felt to be unnecessary, 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 two weeks, contact your midwife, health visitor or GP.

Prolonged newborn jaundice (lasting longer than two weeks) can occur if your baby was born prematurely or if he or she is solely breastfed, and it will usually improve without treatment. However, 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 they have 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 jaundice called kernicterus, which can cause brain damage. See complications of jaundice in babies for more information about this.

Phototherapy

Phototherapy is treatment with light. It is used in some cases of newborn jaundice to lower the bilirubin levels in your baby’s blood through a process called photo-oxidation. Oxidation is the process of adding oxygen to change a substance (in this case, the bilirubin).

The photo-oxidation converts the bilirubin into a substance that dissolves easily in water. This makes it easier for your baby’s liver to break down and remove the bilirubin from their blood.

There are two main types of phototherapy.

Conventional phototherapy – where your baby is laid down under a halogen or fluorescent lamp with their eyes covered to prevent damage to eyes.
Fibre optic phototherapy – where your baby lies on a blanket that incorporates fibre optic cables. Light travels through the fibreoptic cables and shines onto your baby’s back.

In both methods of phototherapy, the aim is to expose your baby’s skin to as much light as possible.

Conventional phototherapy is the treatment tried first in most cases, although fibre optic phototherapy may be used first if your baby was born prematurely. These types of phototherapy will usually be stopped for 30 minutes every three to four hours so that you can feed your baby, change their nappy and give them a hug.

If your baby's jaundice does not improve after conventional or fibre optic phototherapy, continuous multiple phototherapy may be offered. This involves using more than one light and often a fibre optic blanket at the same time.

Treatment will not be stopped during continuous multiple phototherapy. Instead, milk that has been squeezed out of your breasts in advance may be provided through a tube into your baby's stomach, or fluids may be provided into one of their veins (intravenously).

During phototherapy, you baby's temperature will be monitored to ensure they are not getting too hot and they will be checked for signs of dehydration. Your baby may need to have intravenous fluids if they are becoming dehydrated and are not able to drink a sufficient amount.

The bilirubin levels will be tested every four to six hours after phototherapy has started. Once levels start to fall, they will be checked every 6 to 12 hours.

Phototherapy will be stopped when the bilirubin level falls to a safe level, which usually takes a day or two.

Phototherapy is generally very effective for newborn jaundice and it has very few side effects, although your baby may develop a temporary rash or tan as a result of the treatment.

Exchange transfusion

A blood transfusion, known as an exchange transfusion, may be recommended if your baby has particularly high levels of bilirubin in their blood or if phototherapy has not been effective.

During an exchange transfusion, small amounts of your baby's blood are removed through a thin plastic tube placed into blood vessels in their umbilical cord, arms or legs. The blood is then 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 quickly fall.

Your baby will be 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 two hours of treatment to check if it has been successful. If the level of bilirubin in your baby's blood remains high, the procedure may need to be repeated.

Other treatments

If jaundice is caused by an underlying health problem, such as an infection, this will usually need 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.

The immunoglobulin is a solution of antibodies (proteins produced by the body to destroy disease-carrying organisms) from healthy donors. It is injected into a vein (intravenous).

IVIG will usually only be used if phototherapy alone has not worked, and the level of bilirubin in the blood is continuing to rise.

Antibodies: Antibodies are your body's natural defence against any foreign antigens that enter your blood. An antibody is a protein that is produced by the body to neutralise or destroy disease-carrying organisms and toxins.
Blood: Blood supplies oxygen to the body and removes carbon dioxide. It is pumped around the body by the heart.
Liver: The liver is the largest organ in the body. Its main jobs are to secrete bile (to help digestion), detoxify the blood and change food into energy.
Oxygen: Oxygen is an odourless, colourless gas that makes up about 20% of the air we breathe.
Retina: The retina is the nerve tissue lining the back of the eye, which senses light and colour, and sends it to the brain as electrical impulses.