Newborn Jaundice: Symptoms, Causes & When to Seek Care

What Is Newborn Jaundice?

Newborn jaundice (neonatal hyperbilirubinemia) is a common condition where a baby's skin and whites of the eyes turn yellow due to elevated bilirubin levels in the blood. Bilirubin is a yellow pigment produced when red blood cells break down. Most cases are physiological (normal) and resolve without treatment within 1-2 weeks.

Newborn jaundice, medically known as neonatal hyperbilirubinemia, occurs in approximately 60% of full-term newborns and 80% of premature babies during their first week of life. This makes it one of the most common conditions encountered in the newborn period. The characteristic yellow coloring develops because of a temporary imbalance between the production and elimination of bilirubin, a yellow pigment that forms when red blood cells are broken down.

When a baby is in the womb, the mother's liver processes the baby's bilirubin through the placenta. After birth, the baby's own liver must take over this function. In the first few days of life, a newborn's liver is still maturing and may not be able to process bilirubin as quickly as it is being produced. This natural developmental process explains why most newborn jaundice is called "physiological" or normal jaundice.

The medical term for jaundice is icterus, and when it occurs in newborns, it is called icterus neonatorum or neonatal jaundice. Understanding the difference between normal physiological jaundice and pathological (abnormal) jaundice is important for parents, as pathological jaundice requires prompt medical attention to prevent complications.

Why Do Newborns Get Jaundice?

Several factors contribute to the development of jaundice in newborns. During pregnancy, babies have higher levels of red blood cells than they will need after birth because they must extract oxygen from their mother's blood rather than breathing air directly. Once born and breathing on their own, babies no longer need these extra red blood cells, so the body begins breaking them down.

When red blood cells break down, they release a substance called hemoglobin, which is then converted into bilirubin. This bilirubin is processed by the liver and eventually eliminated from the body through urine and stool. In newborns, this elimination process is slower than the production process, leading to a temporary accumulation of bilirubin in the blood and tissues, causing the characteristic yellow discoloration.

What Are the Symptoms of Newborn Jaundice?

The main symptom of newborn jaundice is yellowing of the skin and whites of the eyes (sclera), which typically becomes visible on day 2-3 after birth. The yellow color usually starts on the face and head, then spreads down the body to the chest, abdomen, and legs as bilirubin levels increase.

Recognizing jaundice in your newborn is an important skill for parents. The yellow discoloration is usually easiest to see in natural daylight rather than under artificial lighting, which can mask or alter the appearance of the skin. The yellowing typically follows a pattern, appearing first on the face and forehead before progressing downward to the chest, abdomen, and finally the legs and feet. This progression can help healthcare providers estimate the severity of jaundice.

In babies with darker skin tones, detecting jaundice can be more challenging. Parents and healthcare providers should examine areas where the yellow color may be more visible, including the palms of the hands, soles of the feet, the whites of the eyes, and the inside of the mouth. Gently pressing on the baby's skin can help reveal the yellow color underneath.

Physiological jaundice typically appears 2-3 days after birth, though in some cases it may take a few weeks to become noticeable. The timing of onset is crucial information for healthcare providers, as jaundice appearing within the first 24 hours of life is considered a warning sign requiring immediate medical evaluation.

Symptoms of Mild Jaundice

• Yellow tint to the skin, starting on the face and spreading downward
• Yellowing of the whites of the eyes (scleral icterus)
• Normal feeding behavior and activity level
• Normal urine and stool output
• Baby remains alert and responsive

Symptoms of Severe Jaundice - Warning Signs

While most jaundice is mild and resolves on its own, severe jaundice can develop rapidly and requires immediate medical attention. Recognizing the warning signs of severe jaundice is essential for preventing complications. If bilirubin levels become very high, the substance can cross into the brain and cause damage, a condition called kernicterus, though this is extremely rare with proper monitoring and treatment.

• Deep yellow or orange coloring: The skin takes on an intense yellow or orange hue, often spreading to the arms and legs
• Lethargy: The baby becomes unusually sleepy, difficult to wake, or unresponsive
• Poor feeding: The baby refuses to feed or feeds very weakly
• High-pitched crying: An unusual, shrill cry that sounds different from normal crying
• Arched back: The baby arches their back or neck backward (opisthotonus)
• Floppiness: Decreased muscle tone, with the baby feeling limp when held
• Fever: Elevated body temperature

What Causes Newborn Jaundice?

Newborn jaundice is caused by elevated bilirubin levels in the blood, resulting from the normal breakdown of excess red blood cells combined with the newborn's immature liver function. In most cases, this is a temporary physiological process. Less commonly, underlying conditions such as blood type incompatibility, infection, or enzyme deficiencies can cause pathological jaundice.

Understanding the causes of newborn jaundice helps parents appreciate why it is so common and usually harmless. The primary cause is the natural process of the newborn's body adjusting to life outside the womb. Before birth, babies have a higher concentration of red blood cells to efficiently extract oxygen from their mother's blood through the placenta. After birth, when babies begin breathing air and getting oxygen directly through their lungs, these extra red blood cells are no longer needed.

The body begins breaking down these excess red blood cells, releasing hemoglobin, which is then converted into bilirubin. In adults and older children, the liver efficiently processes bilirubin and eliminates it through bile into the intestines, where it is excreted in stool. In newborns, however, the liver is still developing and may not process bilirubin quickly enough to keep pace with production, leading to accumulation in the blood and tissues.

Additionally, newborns have lower levels of certain bacteria in their intestines that help break down bilirubin for excretion. They also have higher levels of an enzyme that can convert already-processed bilirubin back into a form that can be reabsorbed into the bloodstream, further contributing to elevated levels.

Types and Causes of Newborn Jaundice

Risk Factors for Newborn Jaundice

While any newborn can develop jaundice, certain factors increase the likelihood or severity:

• Premature birth: Babies born before 38 weeks have more immature livers and are at higher risk for significant jaundice
• Blood type incompatibility: When the mother's blood type differs from the baby's (ABO incompatibility) or Rh factors are incompatible
• Sibling with jaundice: A family history of jaundice requiring treatment increases risk
• Bruising during birth: Significant bruising leads to more red blood cell breakdown
• East Asian or Mediterranean heritage: Higher rates of certain enzyme deficiencies (G6PD deficiency)
• Breastfeeding difficulties: Inadequate milk intake in the first days
• Infection: Sepsis or other infections can impair liver function

Breast Milk Jaundice

Breast milk jaundice is a specific type of prolonged jaundice that can occur in breastfed babies, typically appearing between 2 and 6 weeks of age. This form of jaundice is caused by certain substances in breast milk that can affect how bilirubin is broken down and eliminated from the body. Unlike breastfeeding jaundice (which results from inadequate milk intake), breast milk jaundice is not caused by a problem with breastfeeding technique or milk supply.

The good news is that breast milk jaundice does not typically cause high bilirubin levels and is generally harmless. Parents do not need to stop breastfeeding, and the condition usually resolves on its own over several weeks. However, your baby should be examined by a healthcare provider to rule out other causes of prolonged jaundice, such as liver or bile duct problems.

When Should You Seek Medical Care?

Contact your healthcare provider if your baby's skin or eyes become yellow, especially if jaundice appears within 24 hours of birth. Seek immediate medical care if your baby becomes very sleepy, refuses to feed, has a high-pitched cry, or appears limp. These may be signs of severe jaundice requiring urgent treatment.

While most newborn jaundice is harmless and resolves on its own, knowing when to seek medical care is essential for every parent. All newborns should be examined for jaundice before leaving the hospital or birthing center, and again within 3-5 days of birth during the period when bilirubin levels typically peak. Many hospitals perform routine bilirubin screening before discharge.

After returning home, parents should monitor their baby for signs of jaundice and report any concerns to their healthcare provider. It is particularly important to have your baby checked if jaundice appears to be spreading from the face down to the chest, abdomen, or legs, as this progression indicates rising bilirubin levels.

Contact Your Healthcare Provider If:

• Your baby's skin or whites of the eyes become yellow
• The yellow color becomes more intense or spreads to more areas of the body
• Your baby is not feeding well or seems less interested in eating
• Your baby has fewer than 6 wet diapers in 24 hours after the first few days
• Your baby's stool remains dark (black or dark green) after day 4-5
• Jaundice persists beyond 2-3 weeks of age

Seek Immediate Medical Care If:

• Jaundice appears within the first 24 hours of life
• Your baby is extremely sleepy, difficult to wake, or unresponsive
• Your baby refuses to feed or sucks very weakly
• Your baby has an unusual, high-pitched cry
• Your baby appears limp, floppy, or has poor muscle tone
• Your baby arches their back or neck backward
• You notice any signs of illness such as fever

How Is Newborn Jaundice Diagnosed?

Newborn jaundice is diagnosed through visual examination and bilirubin level testing. A transcutaneous bilirubinometer measures bilirubin through the skin non-invasively. If levels appear elevated, a blood test (serum bilirubin) provides a more accurate measurement to determine whether treatment is needed.

Diagnosing newborn jaundice begins with a visual examination by healthcare providers. They will examine your baby's skin and eyes in good lighting, often natural daylight, to assess the extent and intensity of any yellow coloring. By gently pressing on the skin and observing the underlying color, providers can get an initial sense of bilirubin levels. The yellow color progresses from head to toe as levels increase, so jaundice visible only on the face typically indicates lower levels than jaundice visible on the chest or legs.

For a more objective measurement, healthcare providers use a device called a transcutaneous bilirubinometer. This non-invasive tool is placed against the baby's skin, usually on the forehead or chest, and uses light to estimate the bilirubin level in the tissues. Results are available immediately and help determine whether further testing is needed. This screening method has made routine bilirubin assessment much easier and less stressful for babies and parents.

If the transcutaneous reading is elevated, or if clinical concern warrants it, a blood test will be performed to measure the serum (total) bilirubin level precisely. This involves a small blood sample, typically taken from the baby's heel. The blood test provides the most accurate measurement and allows providers to distinguish between different types of bilirubin (conjugated and unconjugated), which can help identify the cause of jaundice in some cases.

What Do Bilirubin Levels Mean?

Bilirubin levels are measured in milligrams per deciliter (mg/dL) or micromoles per liter (µmol/L). The significance of any given level depends on the baby's age in hours, gestational age at birth, and other risk factors. Healthcare providers use standardized charts (nomograms) to assess whether a baby's bilirubin level is in a low-risk, intermediate-risk, or high-risk zone for their age.

For a full-term baby without other risk factors, bilirubin levels below about 12-15 mg/dL typically do not require treatment. However, treatment thresholds are lower for premature babies and those with risk factors. Your healthcare provider will interpret your baby's results in context and recommend appropriate monitoring or treatment.

Additional Tests

In some cases, additional tests may be needed to determine the cause of jaundice, particularly if it appears unusually early, is more severe than expected, or persists longer than normal:

• Blood type testing: To check for ABO or Rh incompatibility between mother and baby
• Coombs test: To detect antibodies that may be destroying the baby's red blood cells
• Complete blood count: To check for signs of infection or excessive red blood cell breakdown
• Reticulocyte count: To assess the rate of red blood cell production
• G6PD screening: To test for glucose-6-phosphate dehydrogenase deficiency, especially in babies from higher-risk populations
• Conjugated bilirubin: If jaundice persists beyond 2-3 weeks, to rule out liver or bile duct problems

How Is Newborn Jaundice Treated?

Most newborn jaundice requires no treatment and resolves with frequent feeding to promote bilirubin elimination. When bilirubin levels are high, phototherapy (light treatment) is the primary treatment, using special blue light to break down bilirubin in the skin. In very rare severe cases, exchange transfusion may be necessary.

The treatment approach for newborn jaundice depends on the severity of hyperbilirubinemia, the baby's age, and any underlying risk factors. For most babies with mild physiological jaundice, no specific medical treatment is needed. The condition resolves naturally as the liver matures and becomes more efficient at processing bilirubin. However, parents play an active role by ensuring adequate feeding to promote bilirubin elimination.

Frequent feeding is the foundation of managing mild jaundice. Bilirubin is eliminated from the body primarily through stool, so ensuring your baby feeds well and has regular bowel movements helps reduce bilirubin levels. For breastfed babies, this typically means 8-12 feedings per day in the early weeks. For formula-fed babies, feeding on demand or approximately every 2-3 hours is recommended.

Phototherapy (Light Treatment)

When bilirubin levels exceed certain thresholds based on the baby's age and risk factors, phototherapy is the primary treatment. Phototherapy, also called "bili lights" or light therapy, uses special blue light that penetrates the skin and converts bilirubin into a form that can be eliminated through urine and stool without requiring liver processing.

During conventional phototherapy, the baby is placed under special lights wearing only a diaper to maximize skin exposure. Soft eye shields protect the baby's eyes from the bright light. Treatment typically continues for 24-48 hours, though the duration depends on how quickly bilirubin levels decrease. Bilirubin levels are monitored regularly during treatment to assess response.

An alternative option is fiberoptic phototherapy, which uses a blanket or pad containing fiberoptic cables that deliver light directly to the baby's skin. This "bili blanket" can be wrapped around the baby, allowing parents to hold and feed their baby during treatment. It is often used for milder cases or as a supplement to conventional phototherapy.

Home Phototherapy

In some cases, when jaundice is mild to moderate and the baby is otherwise healthy, phototherapy may be provided at home. Home phototherapy using a fiberoptic blanket allows families to remain together while treatment continues. Healthcare providers will provide instructions on how to use the equipment and will schedule regular bilirubin checks to monitor progress.

Intensive Phototherapy and Exchange Transfusion

For more severe jaundice or cases that do not respond adequately to standard phototherapy, intensive phototherapy may be used. This involves multiple light sources positioned around the baby to maximize light exposure and accelerate bilirubin breakdown.

In very rare cases where bilirubin levels are dangerously high or rising rapidly despite intensive phototherapy, an exchange transfusion may be necessary. This procedure involves gradually removing the baby's blood and replacing it with donor blood, which removes the excess bilirubin. Exchange transfusion is performed in a neonatal intensive care unit and is reserved for the most severe cases to prevent kernicterus (bilirubin-induced brain damage).

What You Can Do at Home

As a parent, you can take several steps to support your baby's recovery from jaundice:

• Feed frequently: Offer breast milk or formula 8-12 times per day to promote regular bowel movements and bilirubin elimination
• Wake baby to feed: If your baby is sleepy, gently wake them every 2-3 hours for feedings
• Monitor output: Track wet and dirty diapers to ensure adequate feeding
• Watch for warning signs: Monitor for symptoms of severe jaundice and contact your provider if concerned
• Attend follow-up appointments: Keep all scheduled appointments for bilirubin checks
• Seek lactation support: If breastfeeding is challenging, work with a lactation consultant to improve milk transfer

Can Newborn Jaundice Be Prevented?

Physiological jaundice cannot be entirely prevented as it is a normal developmental process. However, ensuring adequate feeding from birth, monitoring for early signs of jaundice, and attending follow-up appointments can help prevent jaundice from becoming severe. For babies at high risk, close monitoring and early intervention reduce complications.

Since physiological jaundice results from normal developmental processes in newborns, it cannot be completely prevented. However, there are important steps that can help minimize the risk of severe jaundice and ensure early detection and treatment when needed.

The most important preventive measure is establishing good feeding from the beginning. Colostrum, the early breast milk produced in the first days, has natural laxative properties that help the baby pass meconium (the first dark stools) quickly. This is important because bilirubin is eliminated through stool, and delayed meconium passage can increase bilirubin reabsorption.

Steps to Reduce Risk of Severe Jaundice

• Begin feeding early: Start breastfeeding within the first hour after birth if possible
• Feed frequently: Aim for 8-12 feedings per day in the first weeks
• Ensure adequate milk transfer: Watch for signs of effective feeding (audible swallowing, satisfied baby, adequate wet/dirty diapers)
• Seek help if needed: Work with healthcare providers or lactation consultants if breastfeeding is difficult
• Attend all newborn check-ups: Bilirubin screening should be done before hospital discharge and again at 3-5 days of age
• Know your risk factors: Inform your healthcare team about family history or other risk factors
• Monitor your baby: Check your baby's skin and eyes daily in natural light during the first two weeks

Prevention of Rh Disease

For mothers who are Rh-negative, receiving Rh immune globulin (RhoGAM) during pregnancy and after delivery can prevent Rh sensitization that could cause severe jaundice in future pregnancies. This is a well-established preventive measure that has dramatically reduced cases of severe hemolytic disease of the newborn.

What Is the Outlook for Babies with Jaundice?

The outlook for babies with newborn jaundice is excellent. The vast majority of cases resolve completely without any lasting effects. With proper monitoring and treatment when needed, serious complications like kernicterus are extremely rare. Most babies with jaundice go on to develop normally with no long-term consequences.

Parents can be reassured that the prognosis for newborn jaundice is overwhelmingly positive. The condition is so common precisely because it represents a normal transitional process as babies adjust to life outside the womb. With the widespread implementation of routine bilirubin screening and effective treatment with phototherapy, serious complications from jaundice have become extremely rare in developed healthcare settings.

Most cases of physiological jaundice resolve completely within the first two weeks of life without any treatment other than supportive care through adequate feeding. Even babies who require phototherapy typically respond well, with bilirubin levels dropping within 24-48 hours of treatment. Once jaundice resolves, there are no lasting effects on the baby's health or development.

The rare complication of kernicterus (bilirubin-induced brain damage) has become extremely uncommon due to improved screening and treatment protocols. When it does occur, it is almost always in cases where jaundice was not recognized or treated appropriately. This underscores the importance of routine monitoring, recognizing warning signs, and seeking timely medical care.