I just gave birth to a baby. But after the first day, she developed jaundice. Why do babies develop jaundice?

Jaundice happens when you have an excess of bilirubin in your blood. The same goes for babies.

Bilirubin gives rise to the yellow colour in the skin and eyes. It is produced because of the breakdown of used red blood cells.

Aren’t red blood cells being broken down all the time? So, why don’t I get jaundice?

When your red blood cells reach the end of their lifetime, which is about four months, they need to be broken down and destroyed to make way for new red blood cells.

Red blood cells contain haemoglobin, which in turn contain haem (a compound that is made out of iron). Haem is metabolised into bilirubin by the liver.

The liver then excretes this bilirubin into your gut, where it is excreted in your stools.

When this whole mechanism works effectively, there is no excess bilirubin in your blood. Therefore, you don’t have jaundice.

I know of many babies who have jaundice. Why is this so?

Infant jaundice is very common indeed. It happens when a baby’s liver isn’t mature enough to metabolise the bilirubin in the baby’s bloodstream.

This usually happens when the baby is born before term, i.e. before 38 weeks of pregnancy.

Some breastfed babies get jaundice too.

In rare cases, the baby’s jaundice is caused by other things.

It is also quite common for jaundice to appear in newborns that are born at term (38 weeks) in the second or third day of their lives, and even, sometimes as late as the fifth day of life.

Such jaundice is called physiologic jaundice.

Why does physiologic jaundice occur?

It is normal for the bilirubin in a baby’s blood to be a bit high after birth.

This is because the mother’s placenta removes bilirubin from the baby’s body when the baby is growing in the womb.

When the baby is born, even at term, his or her liver may not always be mature enough to remove bilirubin on its own.

It takes a few days for the baby’s liver to be able to handle this process well.

Why does jaundice appear in babies that are breastfed?

First of all, jaundice does not appear in all babies that are breastfed, and this should not be an excuse to not breastfeed your baby.

There are two types of jaundice that appear in newborns who are being breastfed.

The first type happens during the baby’s first week of life when he or she doesn’t get enough milk, and is known as breastfeeding jaundice.

When a baby drinks enough breast milk, this increases their bowel movements, which in turn excretes bilirubin.

But if the mother doesn’t produce enough breast milk, if the baby can’t nurse properly or if the baby is given cow milk that interferes with proper breastfeeding, then the baby won’t be able to get enough good bowel movement going.

As a result, there is bilirubin build-up, and hence, jaundice.

Breastfeeding jaundice is not dangerous and usually does not need to be treated.

It will resolve itself with increased feedings and proper feeding techniques.

The second type is breast milk jaundice.

You mean babies can get jaundice from breast milk itself?

Yes. If it does appear, this type of jaundice will appear after the seventh day of life.

It is likely to become worse around week two and three, and last for a month or so.

There is no known cause for this type of jaundice. One theory is that there is a substance in breast milk that blocks the breakdown of bilirubin.

Breast milk jaundice also runs in families.

It is also not dangerous and will resolve in time.

If breast milk jaundice happens, should I stop breastfeeding?

Breast milk jaundice is very rare, only happening in 0.5% to 2.4% of all breastfed babies.

If the baby is feeding well, you should not stop breastfeeding at all.

You mentioned other causes of infant jaundice. What are they?

This type of jaundice appears much earlier or later than physiologic jaundice.

It can be caused by internal bleeding, an infection in your baby’s blood, an incompatibility between the mother and baby’s blood, a liver dysfunction, an enzyme deficiency, or an abnormality in your baby’s red blood cells that causes them to break down too quickly.

How is jaundice treated in babies?

Phototherapy is usually used. This is the ‘blue’ light that you see so often in neo-natal wards, but it is not ultraviolet light.

Other therapies that can be used when the jaundice is more serious are intravenous immunoglobulin or blood exchange transfusion.

Dr YLM graduated as a medical doctor, and has been writing for many years on various subjects such as medicine, health, computers and entertainment. For further information, e-mail starhealth@thestar.com.my. The information contained in this column is for general educational purposes only. Neither The Star nor the author gives any warranty on accuracy, completeness, functionality, usefulness or other assurances as to such information. The Star and the author disclaim all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.