Prolonged Jaundice in Babies: When to Worry and What to Do

Dr Shabrina Saidin

Dr Shabrina Saidin

Director of Klinik Casabrina Senawang, a top-rated healthcare clinic in Senawang. With years of experience in the medical field, Dr. Shabrina helps patients in obstetrics and gynecology.

Don’t ignore prolonged jaundice in newborns. Learn its signs, when to worry, and how doctors treat it to ensure your baby’s well-being.

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prolonged jaundice

Jaundice is a common condition in newborns, affecting nearly 60% of full-term and 80% of preterm babies. While it often resolves on its own within a week or two, some babies experience prolonged jaundice that lingers for several weeks. What does this mean, and should you be concerned? 

What Causes Prolonged Jaundice?

Jaundice occurs when bilirubin, a yellow substance produced during the breakdown of red blood cells, builds up in the blood. Normally, a baby’s liver processes bilirubin and removes it through stool. When this process is delayed or disrupted, jaundice can persist. Here are some common causes:

Breast Milk Jaundice

Breast milk jaundice is one of the most frequent reasons for prolonged jaundice. It’s caused by certain substances in breast milk that temporarily interfere with bilirubin metabolism. The good news? It’s usually harmless and doesn’t require stopping breastfeeding.

Breastfeeding Jaundice

Not to be confused with breast milk jaundice, this type is linked to insufficient milk intake. When a baby isn’t feeding well, dehydration and fewer bowel movements slow down bilirubin elimination.

Hemolysis or Blood Disorders

Conditions like G6PD deficiency or blood type incompatibility between mother and baby (e.g., ABO or Rh incompatibility) can cause the rapid breakdown of red blood cells, leading to excessive bilirubin production.

Infections

Certain infections, such as urinary tract infections or sepsis, can contribute to prolonged jaundice. These cases require immediate medical attention to treat the underlying cause.

Liver or Bile Duct Issues

Rare conditions like biliary atresia (a blockage in the bile ducts) or neonatal hepatitis can impair bilirubin excretion. These are serious but treatable when diagnosed early.

Other Rare Causes

Occasionally, prolonged jaundice may stem from genetic or metabolic disorders like hypothyroidism or Crigler-Najjar syndrome.

Getting a Prolonged Jaundice Workup

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When jaundice persists beyond two weeks in term babies—or three weeks in preterm infants—it’s time to bring your child to a doctor for a closer look.

A prolonged jaundice workup is a detailed evaluation performed when jaundice (yellowing of the skin and eyes) in a newborn lasts beyond two weeks in term babies or three weeks in preterm infants. The workup aims to identify the underlying cause and determine if medical intervention is needed.

A Few Symptoms to Track
Your doctor will begin with a detailed medical history and physical exam. They’ll ask about feeding patterns, stool and urine color, and any family history of blood disorders. The physical exam will focus on signs of underlying diseases, such as liver enlargement, abdominal distension, or other abnormalities.

Tests and Investigations
Next, your baby will undergo some tests. Blood and urine tests are often necessary to pinpoint the cause of jaundice.

Bilirubin Levels: Tests measure both total and direct bilirubin to distinguish between liver-related and other causes. 

Full Blood Count: This helps identify infection, anemia or signs of hemolysis.

Other tests may include thyroid function tests, liver function tests and urinalysis when necessary. For more complex cases, imaging tests like ultrasounds or specialized scans may be needed to evaluate bile ducts and liver structure.

Baby Jaundice Level Chart

Understanding bilirubin levels can help parents and healthcare providers monitor the severity of jaundice. Higher levels or rapid increases in bilirubin are red flags that require immediate evaluation.

Reading (mg/dL)Reading (µmol/L)Notes
0-5 mg/dL85 µmol/LNormal
5-15 mg/dL256 µmol/LLight jaundice, requires close monitoring
15-20 mg/dL342 µmol/LModerate jaundice, requires starting treatment
20 mg/dL and above> 342 µmol/LHeavy jaundice, requires immediate medical attention

Readings of 0-5 mg/dL or 85 µmol/L are considered normal and do not indicate any signs of jaundice. Readings in the range of 5-15 mg/dL or 256 µmol/L suggest mild jaundice, requiring closer monitoring. Readings between 15-20 mg/dL or 342 µmol/L indicate moderate jaundice, where treatment may be necessary to prevent complications. Readings exceeding 20 mg/dL or 342 µmol/L signify severe jaundice, which requires immediate medical attention.

Most doctors typically screen for jaundice shortly after birth. This includes a physical examination to assess skin color and a review of the baby’s feeding patterns and behavior. If jaundice is suspected, a blood test will be conducted to measure bilirubin levels.

In government clinics, bilirubin levels are usually measured in µmol/L. Experienced parents can take note of the initial bilirubin readings to help monitor any changes in their baby’s condition.

When Should You Be Concerned?

Not all cases of prolonged jaundice are alarming, but some symptoms suggest an underlying problem. Call your doctor if your baby:

  • Has poor feeding habits or low energy.
  • Seems excessively sleepy or difficult to wake.
  • Has dark-colored urine or pale stools (a sign of liver or bile duct issues).
  • Shows rapidly increasing jaundice, especially if the eyes or face turn deep yellow.

 

Side Effects of Prolonged Jaundice

Kernicterus

When severe jaundice goes untreated, it can lead to kernicterus, a condition where excessive bilirubin damages the brain. This can result in permanent neurological issues such as cerebral palsy, hearing loss, and developmental delays. Kernicterus is rare but carries life-altering consequences.

Neurological Impairments

Prolonged exposure to high bilirubin levels may cause mild neurological dysfunction, even without kernicterus. Children might experience poor motor coordination, difficulties with concentration, and learning challenges as they grow older.

Vision and Hearing Issues

Elevated bilirubin levels have been linked to sensorineural hearing loss and vision problems. These impairments may persist long-term, requiring interventions like hearing aids or therapy to improve vision tracking and focus.

Liver Dysfunction

When jaundice stems from liver-related issues, such as biliary atresia or hepatitis, untreated cases can lead to chronic liver disease. This may cause liver scarring (cirrhosis), difficulty processing nutrients, and, in severe cases, the need for a liver transplant.

How Is Prolonged Jaundice Treated?

Treatment depends on the cause of jaundice. For breast milk jaundice, most cases resolve on their own with continued breastfeeding and regular monitoring.

Phototherapy

Other cases requires the baby to come into the clinic for phototherapy. This common treatment uses blue light to break down bilirubin in the skin. It’s safe, effective, and often used for moderate to severe jaundice.

Targeted Interventions

For infections or blood disorders, treatment may include antibiotics, blood transfusions, or specific therapies for metabolic conditions. In cases like biliary atresia, early surgery is essential to prevent long-term complications.

Jaundice Screening at Klinik Casabrina Senawang

Prolonged jaundice can be worrying for parents, but in many cases, it’s a manageable condition with the right care. Early diagnosis is key to identifying underlying causes and ensuring your baby’s health. If you’re unsure whether your baby’s jaundice needs further attention, visit our clinic and consult with out our experienced doctor. Klinik Casabrina is well equipped to help you with your child and provide effective treatment.

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