ConditionChildren's health
Neonatal Jaundice (Newborn Jaundice)
Neonatal jaundice is yellowing of a newborn's skin and the whites of the eyes, caused by a buildup of bilirubin, a yellow pigment made when red blood cells break down. It affects about 6 in 10 full-term babies and 8 in 10 premature babies. Most is "physiological": it appears on day 2 to 4 and fades within 2 weeks. Jaundice in the first 24 hours, very high levels, or jaundice lasting beyond 2 to 3 weeks needs prompt checks, because untreated severe jaundice can damage the brain.
Also called: Newborn jaundice, infant jaundice, neonatal hyperbilirubinemia, physiological jaundice
At a glance
- What it is
- Yellow skin and eyes from high bilirubin in the first weeks of life.
- How common
- About 60% of term and 80% of preterm babies.
- Usual type
- Physiological jaundice, appearing day 2 to 4 and gone by 2 weeks.
- Warning signs
- Jaundice in the first 24 hours, very yellow baby, sleepy or poor feeding, pale stools, dark urine.
- Tests
- Skin (transcutaneous) or blood bilirubin, plotted against age in hours.
- Treatment
- Frequent feeding, phototherapy (blue light), and rarely exchange transfusion.
When to get help
Call 911 or go to the ER
- A jaundiced baby who is very sleepy, hard to wake, floppy or not feeding
- High-pitched crying, arching of the neck or back, stiffness or seizures (possible bilirubin affecting the brain)
- Fever of 38 °C (100.4 °F) or higher in a baby under 3 months, or a low temperature, with jaundice
See a doctor within a day or two
- Jaundice that appears in the first 24 hours after birth
- Yellowing spreading to the belly, arms or legs, or getting deeper
- Fewer than 4 to 6 wet diapers a day by day 4 to 5, or stools still dark after day 4
- Pale, chalky or white stools, or dark yellow urine (possible liver or bile duct problem)
- Jaundice lasting beyond 2 weeks in a term baby or 3 weeks in a preterm baby
Book a routine appointment
- Mild yellowing in a baby who is feeding well, alert and making plenty of wet and dirty diapers, at the scheduled newborn checkup within 1 to 3 days of discharge
What causes newborn jaundice
Before birth, babies have extra red blood cells that break down quickly after birth, releasing bilirubin. The newborn liver is still immature and processes bilirubin slowly, and some bilirubin is reabsorbed from the gut. The result is a temporary rise in bilirubin in almost all babies.
Types of neonatal jaundice
| Type | When | Notes |
|---|---|---|
| Physiological | Day 2 to 4, fades by 1 to 2 weeks | Normal, usually mild |
| Breastfeeding (suboptimal intake) jaundice | First week | From not enough milk intake while feeding is established |
| Breast milk jaundice | Starts after day 5 to 7, may last 6 to 12 weeks | Substances in breast milk slow bilirubin removal. Harmless; breastfeeding continues |
| Hemolytic jaundice | Often in the first 24 hours | Rapid red cell breakdown from blood group incompatibility or G6PD deficiency |
| Prolonged or conjugated jaundice | Beyond 2 to 3 weeks | May signal liver disease such as biliary atresia |
Causes of more serious jaundice
- Blood group incompatibility: Rh disease or ABO incompatibility between mother and baby
- G6PD deficiency and other red cell disorders such as hereditary spherocytosis
- Bruising from a difficult birth, including cephalohematoma
- Infection (neonatal sepsis) or urinary tract infection
- Prematurity
- Underactive thyroid (hypothyroidism)
- Biliary atresia and other liver or bile duct conditions, which cause pale stools and dark urine and need surgery early
- Inherited conditions such as Gilbert syndrome and Crigler-Najjar syndrome
Risk factors for severe jaundice
- Birth before 38 weeks
- Jaundice in the first 24 hours
- A sibling who needed phototherapy
- Exclusive breastfeeding with difficulties or significant weight loss
- Bruising or cephalohematoma
- East Asian ancestry
- Blood group incompatibility or G6PD deficiency
How to check for jaundice
Jaundice usually starts on the face and spreads down the body as levels rise. Check in natural daylight by gently pressing the skin on the forehead or nose; yellowing shows as the skin blanches. In babies with darker skin, look at the whites of the eyes, gums and palms. Visual checks are unreliable for measuring how high bilirubin is, so a test is needed if jaundice is noticed.
Diagnosis
- Transcutaneous bilirubin meter: a light device on the skin gives a quick estimate
- Blood test (serum bilirubin): the definitive measurement
- Plotting on a nomogram: results are compared with the baby's age in hours and risk factors, using AAP thresholds for phototherapy
- Further tests when indicated: blood group and Coombs test, blood count, G6PD level, thyroid tests, infection screen, and conjugated bilirubin for prolonged jaundice
All US newborns should have bilirubin screening before discharge and a follow-up check within 1 to 3 days.
Treatment
Feeding
Frequent feeding, 8 to 12 times a day, helps babies pass bilirubin in stool. Breastfeeding support from a lactation consultant can help with latch and milk supply. Supplementation with expressed milk or formula may be advised if intake is low. Water or sugar water should not be given.
Phototherapy
Blue-light therapy changes bilirubin into a form the body can excrete in urine and stool. Babies lie under lights or on a light blanket wearing only a diaper, with eyes protected. It may be done in hospital or, in some cases, at home. Levels are rechecked to decide when to stop. Sunlight through a window is not a safe or effective substitute.
Exchange transfusion
For very high or rapidly rising bilirubin that does not respond to phototherapy, the baby's blood is gradually replaced with donor blood in a neonatal intensive care unit. IV immunoglobulin may be used in some hemolytic cases.
Treating the cause
Antibiotics for infection, thyroid hormone for hypothyroidism, and surgery (Kasai procedure) for biliary atresia, ideally before 2 months of age.
Complications
Very high bilirubin can cross into the brain and cause acute bilirubin encephalopathy, with sleepiness, poor feeding, high-pitched crying and arching. Without urgent treatment it can lead to kernicterus, causing permanent cerebral palsy, hearing loss and problems with eye movements and teeth. Kernicterus is rare and preventable with timely screening and treatment.
Frequently asked questions
What causes jaundice in newborns?
Newborns break down extra red blood cells after birth, producing bilirubin, while their immature liver removes it slowly. This causes normal physiological jaundice. Blood group incompatibility, G6PD deficiency, infection, prematurity, feeding problems and liver conditions can cause more serious jaundice.
When should I worry about newborn jaundice?
Seek urgent care if jaundice appears in the first 24 hours, is spreading or deepening, or if your baby is very sleepy, feeding poorly, has few wet diapers, pale stools or dark urine. Jaundice beyond 2 weeks in a term baby also needs checking.
How long does newborn jaundice last?
Physiological jaundice usually peaks around day 3 to 5 and fades within 1 to 2 weeks. Breast milk jaundice can last 6 to 12 weeks but is harmless. Any jaundice lasting beyond 2 weeks in a term baby needs tests to rule out liver problems.
Should I stop breastfeeding if my baby has jaundice?
Usually not. Frequent breastfeeding helps clear bilirubin. If your baby is not getting enough milk, your provider may suggest extra expressed milk or formula. Stopping breastfeeding is rarely needed, and only briefly on medical advice.
Does sunlight help newborn jaundice?
No. Placing a baby in sunlight is not recommended. It is not effective enough to treat significant jaundice and risks sunburn and overheating. Phototherapy uses specific blue light under medical supervision.
Sources
This guide was written from current patient and clinical guidance, including:
- American Academy of Pediatrics: Clinical Practice Guideline Revision, Management of Hyperbilirubinemia in the Newborn Infant 35 or More Weeks of Gestation (2022)
- CDC: Jaundice and kernicterus
- NICE: Jaundice in newborn babies under 28 days (CG98)
- MedlinePlus: Newborn jaundice
- NHS: Jaundice in newborns