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When Kathleen Goldhar took her then-week-old daughter Kelvey to the hospital, suspecting jaundice, her doctor reluctantly agreed to test her, saying, "If she has jaundice, I'll eat my hat."

Kelvey's skin and eyes didn't have an obvious yellow cast, but it turned out she did have the condition and needed required a week of light therapy to cure it. (Ms. Goldhar was tipped off by her midwife who had administered a blood test.)

Now, concerned that too many jaundice cases are being missed, the Canadian Paediatric Society is recommending that every newborn baby be screened for jaundice with a pinprick to the heel.

Sixty per cent of all newborns experience some form of jaundice and 2 per cent go on to develop severe jaundice. While in most cases jaundice clears up on its own, more serious cases require treatment. If undiagnosed or diagnosed too late, those severely jaundiced babies can develop kernicterus, a life-threatening condition affecting the brain and causing long-term neurological damage.

Of 300,000 babies born in Canada every year, about 30 face severe complications of jaundice, says the author of the CPS recommendations, Keith Barrington, a neonatologist at the Royal Victoria Hospital in Montreal. "We think we can actually prevent that small number by having a slightly different approach to how we manage jaundice in babies," Dr. Barrington says.

According to the new guidelines, after an initial blood test after birth, babies diagnosed with hyperbilirubinemia (an increase of bilirubin, the yellowy byproduct that results from the breakdown of hemoglobin, and causes jaundice and can lead to kernicterus) would be monitored and, if necessary, treated immediately with phototherapy. In extreme cases, babies can need a total blood transfusion.

While she didn't know much about kernicterus at the time, Ms. Goldhar, whose daughter is now 4, says missing the diagnosis would have been horrendous. The new guidelines, she says, sound like a promising development.

They also come at a time when, while there are no long-term data tracing jaundice diagnoses, Dr. Barrington says there is probably a slight increase in the number of severe cases in the past 10 years because of the now-routine early discharge of mothers and newborns from hospital. Since jaundice typically shows up at the three- to five-day mark, cases can slip through the cracks.

Thirty years ago, it used to be routine to stay in the hospital for a week after having a baby, says Christina Templeton, a pediatrician at the Janeway Children's Health and Rehabilitation Centre in St. John's. That longer stay meant that jaundice cases showed up while mother and baby were still in hospital.

Babies who are having trouble breastfeeding are also at a greater risk of developing jaundice as a result of dehydration. But since breastfeeding is widely encouraged, the new guidelines emphasize breastfeeding support for new mothers to ensure that the baby is getting enough milk.

Universal testing advocate Sue Sheridan, whose 12-year-old son, Cal, suffers from kernicterus, founded a non-profit advocacy group called Parents of Infants and Children with Kernicterus.

She cheers Canada's new guidelines as key to combatting the rare but debilitating syndrome and says that a simple test could have spared her son his mental and physical disabilities. Cal now needs a walker to get around, has poor motor functions and challenges with feeding, issues Ms. Sheridan blames on a lax attitude to a syndrome that had been all but eradicated in the 1970s. She says doctors at the time insisted on visual assessments instead of blood tests.

"There's a phenomenon, when something disappears in our health care system or we cure something, it falls off the radar," she says on the phone from Chicago. "And then it starts creeping back."

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Newborn jaundice

Jaundice is the yellowish discoloration in the skin and eyes caused by excess levels of pigment (bilirubin) in the blood. Bilirubin is normally filtered out of the body by the liver as shown.

WHAT GOES WRONG?

-Sometimes a newborn's liver can't cope with the amount of bilirubin being produced, and it accumulates in the body. It can enter the brain cells and cause permanent damage to hearing and mental function, and sometimes lead to death.

-As the circulatory system pumps the blood through the body, the red blood cells are broken down and they release bilirubin and other byproducts.

-The bilirubin and other byproducts are processed and filtered in the liver and become a substance harmless to the body.

-The harmless substance is excreted from the kidneys as urine.

-It is also excreted from the intestines as feces.

SOURCE: GOVERNMENT OF HONG KONG SPECIAL ADMINISTRATIVE REGION

At a disadvantage

Risk factors for developing severe hyperbilirubinemia and the approximate odds ratio compared with the rest of the newborn population:

Shorter gestation (less than 38 weeks): 1.9 - 7.7

Previous sibling with hyperbilirubinemia: 4.8

Visible bruising: 2.6

Male sex: 1.3 - 1.7

Maternal age older than 25 years: 2.6

Asian/European background: 5.2 or 1.2, respectively

Dehydration: Depends on severity

Exclusive and partial Breastfeeding: Very variable in the literature

SOURCE: CANADIAN PAEDIATRIC SOCIETY