Newborn jaundice, or neonatal jaundice, affects around two out of three newborns. In the vast majority of cases, it is harmless: it appears after 24 hours of life and disappears on its own within a few days. However, French recommendations call for systematic measurement in the maternity ward and monitoring after discharge, because a rare severe form can damage the brain.
Here is what the French Society of Neonatology, the French National Authority for Health, and the child's health record recommend, as well as the signs that should prompt a medical consultation.
What is newborn jaundice?
The skin and the whites of the eyes take on a yellow tint because of bilirubin, a pigment produced by the breakdown of red blood cells. The guidelines of the National College of Academic Pediatricians explain why newborns are so susceptible to it:
- they produce two to three times more bilirubin than an adult because they rapidly renew their red blood cells after birth;
- their still-immature liver eliminates it more slowly;
- their intestines, not yet colonized by gut flora, reabsorb some of it.
The same guidelines state that simple jaundice appears after 24 hours, peaks around the 5th or 6th day, and generally disappears before the 10th day.
How many babies are affected?
According to the National College of Academic Pediatricians, neonatal jaundice occurs in two out of three newborns. So-called “breast milk jaundice,” which persists in a healthy breastfed baby, is estimated to affect around 3% of breastfed children.
The feared complication is kernicterus, a neurological condition caused by very high bilirubin levels. The recommendations of the French Society of Neonatology, published in 2017 in Archives de pédiatrie, put its incidence at between 1 in 30,000 births and 1 in 200,000. They describe it as an event “that should never happen,” because appropriate screening and treatment can prevent it.
Newborn jaundice: how is it monitored in the maternity ward?
The 2017 recommendations of the French Society of Neonatology establish three principles:
- never rely on visual assessment alone: visual assessment must always be combined with an instrumental measurement, most often using a transcutaneous bilirubinometer, a device placed on the skin;
- measure it as soon as the mother and baby arrive in the postnatal ward, then every day during the stay;
- interpret each value according to the baby's age in hours, using a reference curve called a nomogram.
A bilirubin level is considered pathological above the 95th percentile on this nomogram, or as soon as jaundice appears within the first 24 hours of life. Measurement on the skin remains a screening tool: it does not replace blood bilirubin testing.
Babies at higher risk
The French Society of Neonatology lists several risk factors for severe jaundice:
- birth before 38 weeks of amenorrhea;
- early jaundice;
- a blood group incompatibility between the mother and child, or a family history of hemolytic disease;
- a hematoma or bruising related to the birth;
- exclusive breastfeeding that is still not very effective, with weight loss of more than 8%.
For babies born prematurely, our article on prematurity in France brings together the official data.
Discharge from the maternity unit: what the HAS recommends
In its March 2014 recommendation on discharge from the maternity unit, the French National Authority for Health makes jaundice a discharge criterion. The baby must not have jaundice requiring phototherapy, and a bilirubin measurement, transcutaneous or blood-based, must be taken at discharge and plotted on the nomogram.
HAS distinguishes between two situations:
- standard discharge, up to 96 hours after a vaginal birth and 120 hours after a cesarean section: first follow-up visit within the week, if possible within 48 hours;
- early discharge, before 72 hours after a vaginal birth or 96 hours after a cesarean section: first visit within 24 hours after discharge.
The French Society of Neonatology adjusts this timeframe according to the value measured at discharge. Below the 40th percentile, the visit takes place after one week. Between the 40th and 75th percentiles, it takes place within 48 to 72 hours, and between the 76th and 95th percentiles, within 24 to 48 hours. Above that, follow-up should be prompt.
To prepare for this return, our article on essentials for returning home and our maternity bag checklist help you get organized without overpacking.
Jaundice and breastfeeding: should you stop?
No. The French Society of Neonatology is explicit: effective exclusive breastfeeding helps prevent severe jaundice. There is therefore never any reason to stop it; instead, it should be supported and optimized.
The recommendations distinguish between two situations. “Starvation” jaundice occurs when the baby does not receive enough milk: they gain less than 20 grams per day and have few stools and wet diapers. “Breast milk” jaundice, which is rare, appears after day 5 in a baby who is gaining weight well. In the first case, breastfeeding support resolves the problem. Our article on breastfeeding in France reviews the official guidelines.
How is significant jaundice treated?
Phototherapy is now the main treatment modality, according to the French Society of Neonatology. The baby is placed under a blue light that transforms bilirubin so it can be eliminated. Treatment thresholds depend on gestational age, age in hours, and risk factors.
None of the recommendations cited suggest exposing the baby to sunlight to treat jaundice. The standard treatment remains phototherapy, as determined by the medical team.
Signs that require prompt medical attention
After discharge, call the maternity unit, your midwife, your doctor, or 15 without delay if:
- the jaundice appeared within the first 24 hours of life;
- the yellowing spreads or intensifies;
- the baby is very sleepy, difficult to wake, or refuses to feed;
- the baby is unusually agitated or lets out an unusual high-pitched cry;
- the baby has few wet diapers or is not gaining weight;
- the jaundice lasts beyond the usual period, which generally ends before day 10.
Pale stools and dark urine: the role of the health record
Another type of jaundice, much rarer, results from a problem with bile drainage. Biliary atresia is one such condition: approximately 50 cases per year in France according to the Ministry of Health, and approximately one newborn in 10,000 according to the university pediatricians’ reference guide. It must be operated on early.
Since the new model that came into effect on April 1, 2018, the health record has included a color chart for stools. Pale, white, or putty-colored stools, especially with dark urine, require prompt medical attention. This screening complements the newborn screening performed at the maternity unit, which does not cover this disease.
Key points
- Newborn jaundice is common and usually harmless.
- It is measured, not assessed by eye: bilirubin is checked before discharge.
- Follow-up after discharge is scheduled according to the measurement, sometimes as early as the next day.
- Breastfeeding does not stop; support is provided.
- Early jaundice, a sleepy baby who feeds poorly, or pale stools require prompt medical advice.
The first few days at home raise many questions. Our article on first outings with a newborn covers what comes next, once this stage has passed.
Sources
- Cortey A., Renesme L., Raignoux J. et al., on behalf of the French Society of Neonatology, “Unconjugated bilirubin jaundice in newborns of 35 weeks and over: from screening to follow-up after discharge from the maternity unit. Clinical practice recommendations,” Archives de pédiatrie, 2017, 24: 192-203.
- French National Authority for Health, “Discharge from the maternity unit after childbirth: conditions and organization of mothers’ and newborns’ return home,” good practice recommendation, March 2014.
- Ministry of Solidarity and Health, “New models of the child health record and health certificates,” information notice, in force as of April 1, 2018.
- National College of University Pediatricians, pediatric reference guide, section “Neonatal jaundice”.
