Welcoming a newborn is a joyful experience, but for many parents, it can also come with a few health concerns that raise questions. One of the most common conditions seen in babies is jaundice, where a newborn’s skin and the whites of their eyes take on a yellowish tint. 

While jaundice is often temporary and resolves within the first two weeks of life, some infants experience prolonged jaundice, which lasts longer than expected.

At Avisena Women’s & Children’s Specialist Hospital, our paediatric specialists frequently guide parents through this condition, ensuring babies receive the right evaluation and care. 

In this article, we’ll provide insights into the causes of prolonged jaundice and the care pathways available, so new parents like you can feel informed and reassured.

What is Prolonged Jaundice?

Jaundice occurs when there is a buildup of bilirubin, a yellow pigment produced during the normal breakdown of red blood cells. In newborns, the still-developing liver may not process bilirubin efficiently, causing it to accumulate. This results in the familiar yellowish appearance. Babies may appear jaundiced, with yellowing of the skin and eyes.

In most cases, neonatal jaundice is considered normal and resolves naturally as the baby’s liver matures. However, jaundice can develop soon after birth, and monitoring in the first days of life is important. When jaundice continues beyond two weeks in term babies (or three weeks in preterm babies), it is referred to as prolonged jaundice.

• Physiological Jaundice: This is the most common form of neonatal jaundice, affecting the majority of newborn babies. It typically appears after the first 24 hours of life, peaks around days 3 to 5, and resolves within one to two weeks. Physiological jaundice results from the natural breakdown of red blood cells and the immature liver’s limited ability to process bilirubin. While usually harmless, monitoring bilirubin levels is important to ensure they do not rise too high.
• Breast Milk Jaundice: Seen in healthy, breastfed infants, breast milk jaundice develops after the first week of life and can persist for several weeks. Certain substances in breast milk may slow the processing of bilirubin, leading to higher serum bilirubin levels. Although this type is generally benign, regular assessment of bilirubin level and the baby’s overall health is recommended.
• Pathological Jaundice: Unlike physiological jaundice, pathological jaundice is caused by underlying medical conditions that require prompt attention. These may include biliary atresia, choledochal cyst, urinary tract infection, sepsis, or blood disorders. Pathological jaundice can present at any age and is often accompanied by warning signs such as dark urine, pale stools, or poor feeding. Early diagnosis through blood count, serum bilirubin, and further investigations is crucial to determine the cause and guide further treatment.
• Conjugated Hyperbilirubinaemia: This type of jaundice is characterised by elevated conjugated bilirubin in the blood, indicating a problem with the liver or bile ducts. Causes include liver disease, biliary atresia, Alagille syndrome, choledochal cyst, hypothyroidism, and certain infections like torch infections. Conjugated hyperbilirubinaemia often presents with pale stool, dark urine, and persistent jaundice. It requires urgent clinical attention, as early intervention can prevent long-term liver damage.

To accurately determine the type of jaundice, healthcare providers rely on a combination of clinical assessment, monitoring of stool colour and urine, and laboratory tests such as full blood count, serum bilirubin level, and liver function tests. 

In some cases, a flow chart or structured approach is used to guide further investigations and management, especially in cases of neonatal cholestasis.

Rare conditions like Alagille syndrome and choledochal cyst, as well as infections and metabolic disorders, can also lead to prolonged or severe jaundice in infants. Early diagnosis and appropriate treatment, ranging from phototherapy and medication to exchange transfusion or surgery, are essential for the best possible outcome.

To sum up, classifying jaundice in newborn babies based on bilirubin levels and underlying causes allows for targeted treatment and helps prevent serious complications. Parents and caregivers should be vigilant for signs such as dark urine, pale stools, or changes in feeding, and seek medical advice promptly for further investigation and management.

1. Breast Milk Jaundice

Some healthy, breastfed babies may experience prolonged jaundice due to substances in breast milk that can affect bilirubin processing. While this is usually harmless, it still requires monitoring.

2. Breastfeeding Difficulties

Inadequate intake of breast milk (often due to latching issues) can result in dehydration or insufficient calories, leading to higher bilirubin levels; therefore, it is important to monitor hydration status in babies with jaundice.

3. Liver or Bile Duct Disorders

Conditions such as biliary atresia (a blockage in the bile ducts) or other liver-related problems can prevent bilirubin from being excreted properly. These are more serious and require early intervention.

4. Infections

Certain infections in newborns, such as urinary tract infections or sepsis, can lead to prolonged jaundice and must be treated promptly.

5. Blood Disorders

Inherited conditions like G6PD deficiency or blood group incompatibilities can cause higher red blood cell breakdown, contributing to sustained jaundice.

Diagnosis and Evaluation

At Avisena Women’s & Children’s Specialist Hospital, paediatric specialists begin with a thorough history and physical examination, during which clinicians assess the baby’s clinical status as part of the evaluation. Key steps include:

• Blood Tests: Performed to measure total and conjugated bilirubin levels, assess the jaundice level, check liver function, and may include a direct antiglobulin test (Coombs’ test) to help determine underlying causes.
• Urine Tests: Performed to detect infections.
• Ultrasound or Imaging: Performed to evaluate the liver and bile ducts if structural issues are suspected.

Early and accurate diagnosis is essential for guiding the right treatment.

Care and Treatment Options

Treatment for prolonged jaundice depends on the underlying cause. Common approaches include:

1. Phototherapy

A standard treatment where the baby is placed under special blue light that helps break down bilirubin into a form the body can eliminate more easily.

The intensity of phototherapy may be adjusted based on the baby’s bilirubin levels, with lower intensity often used as bilirubin decreases to avoid unnecessary interventions.

2. Optimising Feeding

Ensuring the baby feeds well, whether through improving breastfeeding techniques, increasing feeding frequency, or supplementing if necessary.

3. Medication or Surgery

For conditions such as infections, blood disorders, or biliary atresia, more specific interventions like medication—where the correct dose is crucial—and surgical procedures may be required. In certain liver conditions, careful vitamin supplementation, especially of fat-soluble vitamins, should also be considered.

4. Close Monitoring

Even in benign cases, prolonged jaundice requires regular follow-ups to ensure bilirubin levels are decreasing and the baby is thriving.

Don’t Ignore the Warning Signs

While jaundice is common in newborns, prolonged jaundice should never be ignored. By understanding its causes, recognising warning signs, and seeking expert care, parents can ensure their child receives the attention they need for a healthy recovery.

At Avisena Women’s & Children’s Specialist Hospital, our paediatric specialists are committed to providing accurate diagnosis, effective treatment, and compassionate support for families navigating prolonged jaundice. 

If you’re concerned about your baby’s jaundice, don’t wait! Early evaluation is the key to peace of mind and better outcomes.