There are many ways a caregiver can monitor your baby for jaundice and help them decide if and when treatment is required. The method used by your caregiver will depend on the hospital policy and / or your caregiver's preferences and the type of equipment available. Usually the baby is visually observed or the caregiver may use a jaundice meter.
If the method used by your midwife tends to indicate that the levels of bilirubin are becoming high, they will usually notify a paediatric doctor and organise for your baby to have some blood taken to accurately measure their bilirubin level.
Bilirubin blood tests
Observing your baby
Jaundice meters
Bilirubin blood tests
Taking the blood
If your caregiver is concerned that your baby's bilirubin level is becoming too a high, they may suggest a blood test to accurately measure their bilirubin level. Paediatric doctors have written various guidelines stating what an acceptable level of bilirubin should be and when it is recommended that the baby be given treatment. These guidelines may vary from country to country.
Accurate bilirubin levels are obtained by taking a blood sample from the baby and testing it for 'unconjugated' bilirubin (or bilirubin not processed by the liver yet), and sometimes 'conjugated' bilirubin (bilirubin processed by the liver). They may also measure total serum bilirubin (or 'TSB'). Caregivers will often refer to the test as a 'bili' test.
The unconjugated bilirubin level needs to be at least 80 imol / litre before any yellow discolouration can be visually seen in a Caucasian (or fair skinned baby). The level is usually a little higher if the baby is dark skinned. Treatment with phototherapy would be advised if the unconjugated bilirubin level reached 250 imol / litre or more, in a baby that was term (or born after 37 weeks).