Jaundice is a yellow discoloration of the skin and membranes, often most visible in the whites of the eye which become yellow. This is due to a pigment called bilirubin which is made in the liver. Bilirubin is a waste product that’s produced during the normal breakdown of red blood cells. The liver combines bilirubin with bile and it is released into the digestive system and passed out of the body in urine or stools. It is bilirubin that gives urine its light yellow colour and stools their dark brown colour. In certain instances, levels of bilirubin in the blood rise or the normal passage of bilirubin is blocked and it accumulates in the body, causing jaundice.
Jaundice can occur as a result of any condition or disorder that disrupts the functions of the liver, such as sickle cell anaemia, Gilbert’s syndrome or cirrhosis.
It’s very common for newborn babies to be born with the symptoms of jaundice. Newborn jaundice tends not to be a cause for concern. It usually resolves within two weeks without treatment. However, there are instances when there can be complications.
Caution: If you exhibit any of the symptoms of jaundice, seek prompt medical attention, including having blood tests. Other tests may also be needed, such as liver biopsy or ultrasound scanning of the liver.
There are different types of jaundice and these are classified by the point at which disruption to the normal removal of bilirubin from the body occurs.
The three main types are:
- Pre-hepatic jaundice – the disruption occurs before the bilirubin has been transported from the blood to the liver. Most cases of pre-hepatic jaundice are the result of conditions that cause the red blood cells to break down too rapidly, such as malaria or sickle cell anaemia (a genetic blood disorder).
- Intra-hepatic jaundice (also known as hepatocellular jaundice) – the disruption occurs inside the liver. Common causes are conditions that affect the liver, such as alcoholic cirrhosis or hepatitis C. People who are obese can also develop cirrhosis as a result of a build-up of fat inside their liver. This type of liver damage is known as non-alcoholic fatty liver disease.
- Post-hepatic jaundice (also known as obstructive jaundice) – the disruption prevents the bile (and the bilirubin inside it) from draining out of the gallbladder and into the digestive system. A common cause of post-hepatic jaundice is gallstones, which create a blockage in the bile duct system.
Due to the associated risk factors, intra-hepatic and post-hepatic jaundice are more common in middle-aged and elderly people than the young. Pre-hepatic jaundice can affect people of all ages, including children.
The most common symptoms of jaundice are:
- yellowing of the skin, eyes and mucus membrane (the cell lining of the body’s passageways and cavities, such as the mouth and nose)
- pale coloured stools (faeces)
- dark coloured urine
Depending on the underlying cause of your jaundice, you may have a number of additional symptoms.
In cases where jaundice is the result of an infection, such as hepatitis C, you may have symptoms such as:
- a high temperature (fever) of 38ºC (100.4ºF) or above
- abdominal pain
- flu-like symptoms, such as muscle and joint pain
In cases where jaundice is caused by damage to the liver, such as cirrhosis, common additional symptoms include:
- unexplained weight loss
- itchy skin
In cases of post-hepatic jaundice (where an obstruction, such as a gallstone, is preventing bile from draining out of the gallbladder) common additional symptoms include:
- upper abdominal pain
- high temperature
Jaundice in Babies
Jaundice is a common and usually harmless condition in newborn babies that causes yellowing of the skin and the whites of their eyes. (The medical term for this condition is neonatal jaundice.)
Other possible symptoms include:
- dark urine
- pale coloured stools (faeces) instead of bright yellow or orange coloured stools
Symptoms usually develop 2-3 days after birth.
Your baby will usually be checked for jaundice 72 hours after their birth by a midwife or health visitor. However, if your baby develops jaundice after this time contact your licensed health practitioner for advice. While jaundice is not usually a cause for concern it is important to get it checked to see if it needs treating.
Most cases of jaundice in babies do not require treatment as the symptoms normally pass within 10-14 days (although in a minority of cases symptoms can last longer).
Treatment is usually only recommended if tests show a baby has very high levels of bilirubin in their blood (this is known as significant hyperbilirubinaemia). This is because there is a small risk that the bilirubin could pass into the brain and cause brain damage.
There are a number of very effective treatments used to quickly reduce bilirubin levels, including phototherapy – a special type of light that shines on the skin which breaks down bilirubin.
Most babies respond well to treatment and can leave hospital after a few days.
However, sometimes there can be complications.
Excessively high levels of bilirubin cause permanent brain damage. This is known as kernicterus and is rare, affecting less than 1 in every 100,000 births. There were only 7 reported cases of kernicterus in England during 2011.
Kernicterus tends only to be a significant problem in countries with limited access to medical care.
Kernicterus is a rare but serious complication of untreated jaundice in babies caused by excess bilirubin damaging the brain or central nervous system.
In newborn babies with very high levels of bilirubin in the blood (hyperbilirubinaemia), the bilirubin can cross the thin layer of tissue that separates the brain and the blood (the blood-brain barrier).
The bilirubin can damage the brain and spinal cord which can be life threatening.
Brain damage caused by high levels of bilirubin is also called bilirubin encephalopathy.
Your baby may be at risk of developing kernicterus if:
- they have a very high level of bilirubin in their blood
- the level of bilirubin in their blood is rising rapidly
- they do not receive any treatment
Kernicterus is now extremely rare in England affecting less than 1 in a 100,000 babies.
Initial symptoms of kernicterus in babies include:
- decreased awareness in the world around them – for example they may not make any reaction when you clap your hands in front of their face
- their muscles become unusually floppy like a rag doll – this is known as hypotonia
- poor feeding
As kernicterus progresses additional symptoms can include:
- seizures (fits)
- they begin arching their neck or their spine back, or in some cases, both
Treatment for kernicterus involves using an exchange transfusion as used in the treatment of newborn jaundice.
Although if significant brain damage has occurred a child can often develop long-term symptoms that will persist throughout their lifetime, such as:
- cerebral palsy (a condition that affects the brain and nervous system) that causes both increased and decreased muscle tone, and affects your baby’s movement and coordination
- hearing loss – which can range from mild to severe
- learning difficulties – though this tends to be only mild to moderate
- involuntary twitching of different parts of their body
- problems maintaining normal eye movements; people affected by kernicterus have a tendency to gaze upwards or from side to side rather than straight ahead
- the normal development of the teeth can be disrupted resulting in teeth that are misshapen, discoloured and vulnerable to tooth decay.
Jaundice is caused by a build-up of a substance called bilirubin in the blood and tissues of the body.
Bilirubin is a waste product that’s produced when red blood cells break down. Human blood cells have a lifespan of 120 days, after which they’re broken down and replaced with new cells.
The bilirubin is transported in the bloodstream to the liver where specialised cells help to combine it with digestive fluid called bile. Bile is stored in the gall bladder and is released into the digestive system through a series of tubes known as the bile duct system or biliary system.
The bile (and bilirubin contained with it) is converted by bacteria inside the digestive system into a substance called urobilinogen, which is passed out of the body in urine (in very small quantities) or in stools. It is bilirubin that gives urine its light yellow colour and stools their dark brown colour.
Jaundice can occur as a result of any condition, problem or underlying factor that disrupts the movement of bilirubin from the blood to the liver and then out of the body.
Pre-hepatic jaundice occurs when a condition or infection speeds up the breakdown of red blood cells. This results in an increase in bilirubin levels in the blood and triggers the symptoms of jaundice.
Causes of pre-hepatic jaundice include:
- malaria – a blood-borne infection spread by mosquitoes and common in tropical areas of the world
- sickle cell anaemia – a genetic condition that causes red blood cells to develop abnormally; sickle cell anaemia is most common among black Caribbean, black African and black British people
- thalassaemia – a similar genetic condition to sickle cell anaemia in that it affects the production of red blood cells; thalassaemia is most common in people of Mediterranean, Middle Eastern and, in particular, South Asian, descent
- Gilbert’s syndrome – a common genetic condition where the transportation of bilirubin from the blood to the liver is slower than it should be, leading to a build-up of bilirubin in the blood
- Crigler-Najjar syndrome – a rare genetic condition where an enzyme that’s need to help move bilirubin out of the blood and into the liver is missing
- hereditary spherocytosis – an uncommon genetic condition that causes red blood cells to have a much shorter life-span than normal
Intra-hepatic jaundice occurs when damage to the liver, either as the result of infection or exposure to a harmful substance, such as alcohol, disrupts the liver’s ability to process bilirubin.
Causes of intra-hepatic jaundice include:
- the viral hepatitis group of infections – hepatitis A, hepatitis B and hepatitis C
- alcoholic liver disease – where the liver is damaged as a result of alcohol misuse
- leptospirosis – a bacterial infection that’s spread by animals, particularly rats; it’s common in tropical areas of the world and uncommon in the UK
- glandular fever – a viral infection that’s caused by the Epstein-Barr virus
- drug misuse – two leading causes are the recreational drug, ecstasy, and overdoses of the painkiller, paracetamol
- primary biliary cirrhosis – a rare and poorly understood condition that causes progressive liver damage
- liver cancer – a rare and usually incurable cancer that develops inside the liver
- exposure to substances that are known to be harmful to the liver, such as phenol (a compound used in the manufacture of plastic) or carbon tetrachloride (a compound that was widely used in the past in processes such as refrigeration, although now its use is strictly controlled)
- autoimmune hepatitis – a rare condition where the immune system (the body’s natural defence against infection and illness) starts to attack the liver
- primary sclerosing cholangitis – a rare type of liver disease that causes chronic (long-lasting) inflammation of the liver
- Dubin-Johnson syndrome – a rare genetic condition where the liver is unable to combine bilirubin with bile and move it out of the liver
Post-hepatic jaundice is triggered when the bile duct system is damaged, inflamed or obstructed, which results in the gallbladder being unable to move bile into the digestive system
Causes of post-hepatic jaundice include:
- gallstones obstructing the bile duct system
- pancreatic cancer – an uncommon type of cancer that develops inside the pancreas (a gland that helps with the digestion of food)
- gallbladder cancer or bile duct cancer, which are both relatively rare types of cancer
- pancreatitis – inflammation of the pancreas, which can either be acute pancreatitis (the inflammation only lasts for a few days) or chronic pancreatitis (the inflammation lasts for many years)
Causes of jaundice in newborn babies:
There are three main reasons why jaundice is common in new born babies:
- newborn babies have a greater number of red blood cells than adults
- the red blood cells in babies have a shorter lifespan than those found in adults, so they need to be broken down and replaced at a faster rate
- the process to break down and excrete the bilirubin is slower than it is in adults
By the time a baby is two weeks old, they are producing less bilirubin and their liver is more effective at removing it from the body which means the jaundice usually corrects itself without causing harm.
Breastfeeding your baby makes it more likely they will develop jaundice; which tends to last longer than in bottle-fed babies.
The reasons for this are unclear. A number of theories have been suggested, such as:
- when you first start breastfeeding it can be hard to provide all the nutrients your baby requires so they are not getting nutrients and fluids necessary to help their body break down and excrete bilirubin; this tends to only be a short-term issue
- breastfeeding may somehow cause the bilirubin in the intestines (part of the digestive system) to be re-absorbed back into the blood, instead of being passed out
- it is also possible that breast milk contains an unidentified, but harmless, substance that causes jaundice in newborn babies
If you are breastfeeding your baby, continue to do so even if your baby has symptoms of jaundice as they will pass in time. Benefits of breastfeeding outweigh any potential risks associated with jaundice. You may wish to discuss this further with your licensed health practitioner or midwife.
Your baby is more likely to need treatment for high levels of bilirubin in their blood if:
- they were born before the 38th week of your pregnancy
- you have another child that needed treatment for jaundice
- you intend to only breastfeed your baby (not bottle-feed as well)
- they develop jaundice within 24 hours of being born
There is also some evidence that babies with a low birth weight (less than 2 and a half kilos or 5.5 pounds) are more likely to need treatment for jaundice.
In some cases, jaundice may have an alternative cause. Some of these are described below.
- An underactive thyroid gland (hypothyroidism).
- Blood group incompatibility, when the mother and baby have different blood types, and these are mixed during the pregnancy or the birth.
- Rhesus factor disease, a condition that can occur if the mother has rhesus-negative blood, and the baby has rhesus-positive blood.
- An inherited enzyme deficiency (enzymes are proteins that speed up and control chemical reactions in the body), such as a deficiency of glucose-6-phosphate-dehydrogenase (G-6-PD), an enzyme that helps red blood cells function.
- The baby experiences bleeding in and around the skull (cephalohaematoma) due to a difficult delivery – this condition is not usually serious.
- The mother of the baby has diabetes.
- The baby has a urinary tract infection (an infection, usually bacterial, that develops inside any part of the body used to pass urine, such as the bladder)
- Crigler-Najjar syndrome, an inherited condition that adversely affects the enzyme responsible for processing bilirubin, leading to an excess build up of bilirubin.
- An obstruction or defect in the biliary system. The biliary system is made up of the bile ducts and gall bladder, and it creates and transports bile (a fluid used to help digest fatty foods).
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Foods to prevent and treat jaundice: www.articlesbase.com/diseases-and-conditions-articles/foods-to-prevent-and-treat-jaundice-6115738.html
Jaundice and homeopathy: www.whereincity.com/medical/topic/diet-and-nutrition/articles/754.htm
Jaundice and acupuncture: tcm.health-info.org/Acupunture/treatment/jaundice.htm
Chinese herbs for jaundice: taoofmedicine.com/tag/chinese-herbs-for-jaundice
Home remedies for jaundice: www.homeremedycentral.com/en/home-remedies/natural-cure/jaundice.html
Herbal cure for jaundice: www.livestrong.com/article/390360-herbal-cure-for-jaundice
Natural treatment for jaundice: www.youtube.com/watch?v=QY_edI9wodk
Home ayurveda treatments for jaundice: /www.youtube.com/watch?v=nyl4mQz_98M
Herbs effective in curing jaundice: articles.timesofindia.indiatimes.com/2011-07-06/varanasi/29742818_1_bilirubin-jaundice-hepatitis
Breast milk jaundice and maternal diet with Chinese herbal medicines: www.hindawi.com/journals/ecam/2012/150120/
Further Information (links and books)
Herbal Treatment for Jaundice and Liver Disorders (Herbal Cure) by Vaidya Bhagwan Dash
Andrea Butje | Aromahead firstname.lastname@example.org – aromatherapy
Carrie Vitt email@example.com – organic food recipes.
David Spector-NSR/USA firstname.lastname@example.org – meditation, stress
Judith Hoad email@example.com – herbalist.
Kath May firstname.lastname@example.org – reiki, tai chi.
Lillian Bridges email@example.com – Chinese medicine, living naturally.
Monika firstname.lastname@example.org – aromatherapy.
Rakesh GAC@AyurvedicLifeStyles.com – Ayurvedic Practitioner.