My baby is said to have Jaundice 24 hours after delivery, I can’t understand why a new born baby is having Jaundice. Is it life threatening?

Question: Hi doctor, I just gave birth to my second child through CS at 38 weeks through elective surgery; and my baby is said to have Jaundice 24 hours after delivery, I think I have heard the word Jaundice before –in adult, but surely can’t remember what it means and I can’t understand why a new born baby is having Jaundice. Is it life threatening?

Doctors Response: Congratulations on the birth of your baby. Jaundice is a yellowish pigmentation of the skin over the whites of the eyes and other mucous membranes. It is caused when blood bilirubin levels are high. A normal concentration of bilirubin in blood plasma is normally below 1.2 mg/dL, a concentration higher than this (i.e. greater than 3mg/dL will lead to Jaundice. Jaundice affects at least two-thirds of all babies in the first week of life and is often a common reason for readmission to the hospital immediately after birth. Jaundice shows the immaturity of the liver’s excretory pathway for bilirubin at a time of heightened production. Babies’ bilirubin is always high over the first few days of life but is not apparent on the first day of life. However any visible jaundice in the first 24 hours of delivery must be urgently investigated as it is assumed to be due to rhesus incompatibility, ABO incompatibility, glucose 6-Phosphate dehydrogenase deficiency until proven otherwise.

Although neonatal jaundice is usually benign but it shouldn’t be taken slightly or assume that new born are immune from kernicterus which is a serious form of yellow staining of the basal ganglia by bilirubin. The survivors end up with deafness, handicapped by athetoid celebral palsy, dental enamel dysplasia etc. The risk of kernicterus is high for an infant of 37 weeks compared to one of 41 weeks. It is very important for those who came in contact with the baby to be able to know if it is jaundice or otherwise. This can be done by assessing the level of the jaundice using a transcutaneous bilirubinometer in babies with gestational age 35 weeks or more and postnatal age of more than 24 hours. If this is not available, a measurement of the serum bilirubin should be done. It is always good to use serum bilirubin measurement to determine the bilirubin level in babies. Visual inspection alone to estimate the bilirubin level in a baby with a jaundice should not be accepted.

Regardless, phototherapy when used correctly is a good way of converting even a 5^th unconjugated bilirubin to harmless photoisomers within few hours.