A seasoned mother of six, Nurliza Abdul Aziz, 39, has experienced the highs and lows of motherhood. But there’s one thing she never quite gets used to – the sound of her newborns’ cries when their jaundice levels are tested. Then, there’s also the stress of taking her babies to the polyclinic while recovering from childbirth and juggling her children’s schedules.
All of her children experienced neonatal jaundice, a condition that makes the whites of the eyes and skin appear yellow.
“Imagine having to go to the polyclinic every two days to get your baby’s jaundice levels checked – that’s tough for postpartum mums,” said Nurliza, a quality service assistant manager. “Sometimes, they get their heels pricked for a blood sample. Of course, the babies will cry – so poor thing.”
All of Nurliza Abdul Aziz’s children had neonatal jaundice when they were newborns. (Photo: Nurliza Abdul Aziz
Recalling her anxiety when her firstborn – now aged 11 – developed jaundice, Nurliza turned to herbal baths using traditional Chinese herbs, hoping it would help. “I just wanted the jaundice to clear as fast as possible,” she explained.
Now, with more experience, she has learned to manage the condition with more confidence. “I’ve realised that even without the herbal baths, my babies’ jaundice still cleared up on its own by two weeks,” she said.
Her experience shows that while neonatal jaundice is common, it can be a stressful and daunting time for new parents. Myths and misconceptions surrounding the condition can also complicate matters.
“Imagine having to go to the polyclinic every two days to get your baby’s jaundice levels checked – that’s tough for postpartum mums,” said Nurliza,Abdul Aziz. (Photo: Nurliza Abdul Aziz)
Experts told CNA Lifestyle that while neonatal jaundice is usually harmless and resolves on its own, early detection and regular monitoring are important. This is because severe jaundice can have serious long-term repercussions, including brain damage and even death.
Here’s what parents should know about neonatal jaundice:
In Singapore, around 60 per cent of full-term babies and 85 per cent of premature babies develop jaundice in the first week of their lives, according to Dr Tan Ngiap Chuan, director of Research and Primary Care Research Institute at SingHealth Polyclinics.
Neonatal jaundice occurs when bilirubin – a substance created when red blood cells break down – builds up in the body. Normally, the liver processes bilirubin. “In newborns however, their liver might not be mature enough to handle it efficiently yet,” explained Dr Alvin Ngeow, senior consultant with the Department of Neonatal and Developmental Medicine at Singapore General Hospital (SGH).
The condition is more common in premature babies and in some cases, for example, when there are differences between the mother’s and baby’s blood types, certain infections or genetic conditions such as G6PD deficiency.
Babies who sustain bruising or haematoma (an accumulation of clotted blood) due to trauma during delivery, such as excessive force from the use of forceps, are also more susceptible to neonatal jaundice, Dr Tan added.
A newborn baby infant with neonatal jaundice. (Photo: iStock/Smith Assavarujikul)
Jaundice peaks around the third to fifth day after birth for most babies, said Dr Ngeow. The condition is usually transient and resolves when the bilirubin levels drop to safe levels by around one to two weeks in full-term babies, or up to three weeks for premature babies.
“If the jaundice persists beyond these time frames, consult a doctor as it may indicate underlying conditions such as liver problems, infections or genetic or metabolic disorders,” Dr Ngeow advised.
Most bilirubin is eventually removed through the baby’s stools after being processed by the liver. In some cases however, too much bilirubin can enter the brain, which is why it is important for babies to be assessed and monitored, said Dr Tan.
“Babies with rapid rise in level of bilirubin over a short period of time are at risk of brain damage from kernicterus, or excessive deposits of bilirubin in the brain,” he said. This can result in long-term complications such as intellectual and motor disabilities, developmental delays or even death.
Routine screenings are essential to monitor a newborn’s bilirubin levels during the first two to three weeks of life. Typically, this involves frequent clinic visits.
Currently, screening involves the use of a light-emitting handheld gadget to measure the skin’s yellowness or a heel prick for a blood sample.
Parents should adhere to the healthcare team’s recommendation for follow-up visits, instead of relying on visual estimation of their baby’s skin colour changes. Studies show that this method can be unreliable with inconsistent results, depending on who performs it, Dr Ngeow said.
That said, if you notice dark urine and pale stools, seek medical attention immediately as these are red flags for a more serious form of jaundice known as conjugated jaundice, he added.
Exposing jaundiced babies to indirect sun was once a common practice, but this is no longer recommended as it can be harmful. Dr Ngeow explained that while sunlight can help reduce bilirubin levels, it carries risks; your baby can get sunburnt, dehydrated and overheat.
Sunbathing babies carries risks of sunburns, dehydration and overheating. (Photo: iStock/Srisakorn)
“Unlike phototherapy, sunlight exposure cannot be precisely controlled for duration or intensity, making it an unreliable and potentially harmful approach. Medical phototherapy with controlled light wavelengths is much safer and more effective,” he said.
If you are a new parent, you are likely to receive an avalanche of advice from family and friends on how best to care for your jaundiced baby. While well-meaning, not all suggestions are helpful and some – like consuming specific herbs or bathing your baby in Guinness Stout beer – may leave you scratching your head.
Dr Ngeow shared that certain traditional Chinese herbs, when consumed by breastfeeding mothers, can aggravate jaundice in newborns. Examples of some herbs that have been highlighted as potentially harmful in clinical practice guidelines in Singapore include Chuen-Lin (also known as Coptis chinensus or goldthread rhizome) and Yin-Chen (also known as oriental wormwood or artemisia).
Breastfeeding mothers should avoid certain traditional herbs as they may aggravate baby’s jaundice. (Photo: iStock/Govan Zhang)
As for the idea of giving baby a frothy beer bath, Dr Ngeow raised concerns about the lack of studies on its safety and efficacy, and highlighted potential issues that may occur.
Beer is carbonated and that may cause discomfort to the sensitive skin of newborns. Moreover, alcohol evaporates quickly, which can lower body temperature. Infants cannot regulate their body temperature as well as adults, and tends to lose heat more easily.
Frequent feeding plays a vital role in eliminating bilirubin from the body as it keeps them well-hydrated, and encourages regular wet and soiled diapers.
Frequent and effective breastfeeding keeps baby hydrated, which helps the body eliminate bilirubin. (Photo: iStock/geargodz)
In some cases, breastfed babies may experience breastfeeding jaundice. However, Dr Ngeow emphasised that this is not caused by the mother’s breast milk, but instead, due to insufficient breast milk intake.
Mothers are encouraged to continue breastfeeding, but those who face difficulties breastfeeding may need to get proper support from lactation consultants and nurses, he advised.
Home-based phototherapy is a treatment option for some babies with jaundice. This involves using specialised equipment, such as a lighted bed or a blanket that uses fibre optic technology to transmit blue light.
Large-scale studies show that it is effective, safe, cost-effective and can reduce parental stress, shared Dr Ngeow. “However, parents should receive proper instructions from healthcare professionals on how to use the device and monitor baby’s condition. Regular follow-ups with the doctor are also essential,” he added.
A new screening tool using a smartphone app may soon change how neonatal jaundice is monitored in Singapore. Called BiliSG, the artificial intelligence (AI)-powered app enables parents to monitor their infant’s jaundice at home using a smartphone camera to capture images of the baby’s forehead, chest and abdomen.
Jointly developed by SGH, SHP and national healthtech agency Synapxe, the app is specifically designed for the skin tones of Asian babies.
BiliSG being used on an infant to monitor their bilirubin levels. (Photo: Singapore General Hospital)
According to Dr Ngeow, the principal investigator, results from a study involving nearly 550 newborns showed that the app successfully identified all babies with significantly elevated bilirubin levels, ensuring that no high-risk cases were missed.
The app is currently not available to the general public. Further testing is underway. Dr Ngeow shared plans to recruit about 2,000 babies in the next phase, some of whom will undergo a clinical pilot study that allows parents to use the app at home and receive medical advice from polyclinic doctors through teleconsultation.
For parents like Nurliza, this innovation would mean fewer in-person clinic visits and greater peace of mind.
“When I heard about the (BiliSG) app, I was so happy,” she said. “It’s really time for such technology to be available because waiting times at the clinics can be quite long. A newborn’s immune system is not strong, so it’d be best to stay at home instead of taking them to crowded areas,” she said.
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All of her children experienced neonatal jaundice, a condition that makes the whites of the eyes and skin appear yellow.
“Imagine having to go to the polyclinic every two days to get your baby’s jaundice levels checked – that’s tough for postpartum mums,” said Nurliza, a quality service assistant manager. “Sometimes, they get their heels pricked for a blood sample. Of course, the babies will cry – so poor thing.”
All of Nurliza Abdul Aziz’s children had neonatal jaundice when they were newborns. (Photo: Nurliza Abdul Aziz
Recalling her anxiety when her firstborn – now aged 11 – developed jaundice, Nurliza turned to herbal baths using traditional Chinese herbs, hoping it would help. “I just wanted the jaundice to clear as fast as possible,” she explained.
Now, with more experience, she has learned to manage the condition with more confidence. “I’ve realised that even without the herbal baths, my babies’ jaundice still cleared up on its own by two weeks,” she said.
Her experience shows that while neonatal jaundice is common, it can be a stressful and daunting time for new parents. Myths and misconceptions surrounding the condition can also complicate matters.
“Imagine having to go to the polyclinic every two days to get your baby’s jaundice levels checked – that’s tough for postpartum mums,” said Nurliza,Abdul Aziz. (Photo: Nurliza Abdul Aziz)
Experts told CNA Lifestyle that while neonatal jaundice is usually harmless and resolves on its own, early detection and regular monitoring are important. This is because severe jaundice can have serious long-term repercussions, including brain damage and even death.
Here’s what parents should know about neonatal jaundice:
1. IT AFFECTS MORE THAN HALF OF FULL-TERM BABIES
In Singapore, around 60 per cent of full-term babies and 85 per cent of premature babies develop jaundice in the first week of their lives, according to Dr Tan Ngiap Chuan, director of Research and Primary Care Research Institute at SingHealth Polyclinics.
Neonatal jaundice occurs when bilirubin – a substance created when red blood cells break down – builds up in the body. Normally, the liver processes bilirubin. “In newborns however, their liver might not be mature enough to handle it efficiently yet,” explained Dr Alvin Ngeow, senior consultant with the Department of Neonatal and Developmental Medicine at Singapore General Hospital (SGH).
The condition is more common in premature babies and in some cases, for example, when there are differences between the mother’s and baby’s blood types, certain infections or genetic conditions such as G6PD deficiency.
Babies who sustain bruising or haematoma (an accumulation of clotted blood) due to trauma during delivery, such as excessive force from the use of forceps, are also more susceptible to neonatal jaundice, Dr Tan added.
A newborn baby infant with neonatal jaundice. (Photo: iStock/Smith Assavarujikul)
2. NEONATAL JAUNDICE USUALLY RESOLVES BY 2 TO 3 WEEKS
Jaundice peaks around the third to fifth day after birth for most babies, said Dr Ngeow. The condition is usually transient and resolves when the bilirubin levels drop to safe levels by around one to two weeks in full-term babies, or up to three weeks for premature babies.
“If the jaundice persists beyond these time frames, consult a doctor as it may indicate underlying conditions such as liver problems, infections or genetic or metabolic disorders,” Dr Ngeow advised.
3. SEVERE JAUNDICE CAN CAUSE BRAIN DAMAGE
Most bilirubin is eventually removed through the baby’s stools after being processed by the liver. In some cases however, too much bilirubin can enter the brain, which is why it is important for babies to be assessed and monitored, said Dr Tan.
“Babies with rapid rise in level of bilirubin over a short period of time are at risk of brain damage from kernicterus, or excessive deposits of bilirubin in the brain,” he said. This can result in long-term complications such as intellectual and motor disabilities, developmental delays or even death.
4. DON’T SKIP FOLLOW-UP CLINIC VISITS
Routine screenings are essential to monitor a newborn’s bilirubin levels during the first two to three weeks of life. Typically, this involves frequent clinic visits.
Currently, screening involves the use of a light-emitting handheld gadget to measure the skin’s yellowness or a heel prick for a blood sample.
Parents should adhere to the healthcare team’s recommendation for follow-up visits, instead of relying on visual estimation of their baby’s skin colour changes. Studies show that this method can be unreliable with inconsistent results, depending on who performs it, Dr Ngeow said.
That said, if you notice dark urine and pale stools, seek medical attention immediately as these are red flags for a more serious form of jaundice known as conjugated jaundice, he added.
5. SUNBATHING IS NO LONGER RECOMMENDED
Exposing jaundiced babies to indirect sun was once a common practice, but this is no longer recommended as it can be harmful. Dr Ngeow explained that while sunlight can help reduce bilirubin levels, it carries risks; your baby can get sunburnt, dehydrated and overheat.
Sunbathing babies carries risks of sunburns, dehydration and overheating. (Photo: iStock/Srisakorn)
“Unlike phototherapy, sunlight exposure cannot be precisely controlled for duration or intensity, making it an unreliable and potentially harmful approach. Medical phototherapy with controlled light wavelengths is much safer and more effective,” he said.
6. APPROACH HERBAL AND HOME REMEDIES WITH CAUTION
If you are a new parent, you are likely to receive an avalanche of advice from family and friends on how best to care for your jaundiced baby. While well-meaning, not all suggestions are helpful and some – like consuming specific herbs or bathing your baby in Guinness Stout beer – may leave you scratching your head.
Dr Ngeow shared that certain traditional Chinese herbs, when consumed by breastfeeding mothers, can aggravate jaundice in newborns. Examples of some herbs that have been highlighted as potentially harmful in clinical practice guidelines in Singapore include Chuen-Lin (also known as Coptis chinensus or goldthread rhizome) and Yin-Chen (also known as oriental wormwood or artemisia).
Breastfeeding mothers should avoid certain traditional herbs as they may aggravate baby’s jaundice. (Photo: iStock/Govan Zhang)
As for the idea of giving baby a frothy beer bath, Dr Ngeow raised concerns about the lack of studies on its safety and efficacy, and highlighted potential issues that may occur.
Beer is carbonated and that may cause discomfort to the sensitive skin of newborns. Moreover, alcohol evaporates quickly, which can lower body temperature. Infants cannot regulate their body temperature as well as adults, and tends to lose heat more easily.
7. FEEDING YOUR BABY FREQUENTLY HELPS FLUSH OUT BILIRUBIN
Frequent feeding plays a vital role in eliminating bilirubin from the body as it keeps them well-hydrated, and encourages regular wet and soiled diapers.
Frequent and effective breastfeeding keeps baby hydrated, which helps the body eliminate bilirubin. (Photo: iStock/geargodz)
In some cases, breastfed babies may experience breastfeeding jaundice. However, Dr Ngeow emphasised that this is not caused by the mother’s breast milk, but instead, due to insufficient breast milk intake.
Mothers are encouraged to continue breastfeeding, but those who face difficulties breastfeeding may need to get proper support from lactation consultants and nurses, he advised.
8. HOME TREATMENT CAN BE AN OPTION FOR SOME BABIES
Home-based phototherapy is a treatment option for some babies with jaundice. This involves using specialised equipment, such as a lighted bed or a blanket that uses fibre optic technology to transmit blue light.
Large-scale studies show that it is effective, safe, cost-effective and can reduce parental stress, shared Dr Ngeow. “However, parents should receive proper instructions from healthcare professionals on how to use the device and monitor baby’s condition. Regular follow-ups with the doctor are also essential,” he added.
9. PARENTS MAY SOON MONITOR THEIR BABIES’ JAUNDICE AT HOME WITH AN APP
A new screening tool using a smartphone app may soon change how neonatal jaundice is monitored in Singapore. Called BiliSG, the artificial intelligence (AI)-powered app enables parents to monitor their infant’s jaundice at home using a smartphone camera to capture images of the baby’s forehead, chest and abdomen.
Jointly developed by SGH, SHP and national healthtech agency Synapxe, the app is specifically designed for the skin tones of Asian babies.
BiliSG being used on an infant to monitor their bilirubin levels. (Photo: Singapore General Hospital)
According to Dr Ngeow, the principal investigator, results from a study involving nearly 550 newborns showed that the app successfully identified all babies with significantly elevated bilirubin levels, ensuring that no high-risk cases were missed.
The app is currently not available to the general public. Further testing is underway. Dr Ngeow shared plans to recruit about 2,000 babies in the next phase, some of whom will undergo a clinical pilot study that allows parents to use the app at home and receive medical advice from polyclinic doctors through teleconsultation.
For parents like Nurliza, this innovation would mean fewer in-person clinic visits and greater peace of mind.
“When I heard about the (BiliSG) app, I was so happy,” she said. “It’s really time for such technology to be available because waiting times at the clinics can be quite long. A newborn’s immune system is not strong, so it’d be best to stay at home instead of taking them to crowded areas,” she said.
Continue reading...