Jaundice is a condition whereby the skin and the whites of the eyes turn yellowish due to a high level of bilirubin in the blood.

Bilirubin is a yellow substance normally produced when old red blood cells are broken down. It is then metabolised by the liver so that it can be removed from the body.

About half of all newborns are affected by neonatal jaundice in the first few days of life.

In the transition after birth, foetal haemoglobin (HbF) will be destroyed to be replaced by adult haemoglobin (HbA). The destruction of HbF releases iron and bilirubin.

It is this excess bilirubin that causes physiological jaundice if the liver does not remove it.

This is the most common cause of jaundice in newborns. It often manifests when the newborn is two to four days old and resolves within two weeks.

It is usually harmless, if bilirubin levels remain stable.

If your newborn appears yellow, the paediatrician will do a blood test to measure his bilirubin level.

If the condition is mild, you may continue caring for him as usual and are advised to breastfeed him regularly. This will encourage frequent bowel movements to remove bilirubin through the stools.

Scheduled evaluations with the doctor may be needed.

A common treatment is by phototherapy, where the newborn is placed under a special blue light, which helps to break down excess bilirubin. Doctors may also recommend the therapy to be done at home.

In severe cases, a blood exchange transfusion may be needed to prevent brain damage.

There are many misconceptions linked to jaundice. Here are clarifications to some of the widely-believed myths.

Myth: Neonatal jaundice is caused by food, drugs, pregnancy conditions or inheritance from the mother.

Fact: Based on current science, there is absolutely no link between these factors and neonatal jaundice. Jaundice is highly unlikely to be passed down from mother to child.

Apart from the mild jaundice that is physiological, severe neonatal jaundice may happen in rare occasions, caused by pathological conditions such as:

• Blood type mismatch between the mother and baby (i.e. when the mother has Rh-negative blood and her baby has Rh-positive blood; the mother’s antibodies may enter the baby’s blood through the placenta and destroy his red blood cells, hence producing bilirubin).

Even mothers with blood group O+ with babies of another blood group can cause baby to have jaundice.

• Babies with glucose-6-phosphate dehydrogenase (G6PD) deficiency.

• Abnormal blood cell shapes (e.g. sickle cell anaemia).

• Diseases that affect the liver and biliary tract (e.g. cystic fibrosis, hepatitis).

• Infections at birth (e.g. rubella, syphilis).

Myth: Neonatal jaundice is harmless and does not need any attention.

Fact: Most of the time, neonatal jaundice is harmless, but parents should always be concerned with the condition and keep track of the bilirubin level to prevent it from getting worse.

A very high level of bilirubin can affect hearing and cause kernicterus, a form of brain damage.

Immediately consult your doctor in any of these situations:

• Jaundice appearing within the first 24 hours of life (pathological jaundice)

• Rapid progression of jaundice

• Newborn screening shows G6PD deficiency

• Previous babies in your family have severe neonatal jaundice

• Presence of pale-coloured stools or dark urine

• Your baby is born preterm

Myth: Jaundice can be treated with sunlight therapy.

Fact: This is not advised as it is not effective and may be dangerous.

A newborn may become dehydrated when placed under the sun, making the condition worse.

Direct sunlight and UV rays can cause painful sunburn to the thin newborn skin.

Myth: Feed newborns with water to ‘flush out’ the jaundice.

Fact: Sometimes, newborns who are exclusively breastfed may have prolonged jaundice, but it is not a reason to stop breastfeeding or to supplement it with water.

As long as breastfeeding mothers are not taking traditional medicines, and the baby is healthy and gaining weight, exclusive breastfeeding should be continued.

In fact, mothers are recommended to nurse newborns at least eight to 12 times a day during the first few days to tackle jaundice.

Myth: Goat’s milk can help in neonatal jaundice.

Fact: There is no proper clinical study that shows goat’s milk is effective for neonatal jaundice. Moreover, the newborns’ digestive system and liver are still immature and unable to digest goat’s (and cow’s) milk, both of which do not have the right nutrients required, compared to breastmilk.

Myth: Newborns afflicted with jaundice may get it later in life.

Fact: Most neonatal jaundice cases are physiological and only happen during the first few days of life.

Jaundice that manifests later in life has no link to neonatal jaundice.

As common as it may be, neonatal jaundice can still lead to severe complications, if it is not managed and treated properly.

Proper consultation with your child’s paediatrician to keep track of his jaundice is vital during the first few days of life. Clarify your doubts with your doctor to avoid inaccurate information related to the condition.

Datuk Dr Zulkifli Ismail is a consultant paediatrician and paediatric cardiologist. This article is courtesy of the Malaysian Paediatric Association’s Positive Parenting programme in pollaboration with expert partners. For further information, please e-mail starhealth@thestar.com.my or visit www.mypositiveparenting.org. The information provided is for educational and communication purposes only and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader’s own medical care. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this column. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.