Jaundice in Newborns: Causes, Symptoms, Treatment & Prevention

Introduction

Jaundice in newborns happens when the level of bilirubin in the baby’s blood becomes high. Bilirubin is a yellow substance formed when old red blood cells break down and are replaced. The liver usually converts bilirubin into a form that can be removed from the body through stool. When bilirubin builds up, it can cause the baby’s skin and the white part of the eyes to appear yellow¹.

In newborn babies, this can happen because they have a higher number of red blood cells which break down more often. At the same time, a newborn’s liver is still developing and may not remove bilirubin efficiently during the first few days after birth. As the baby grows, the liver becomes stronger and works better. By around two weeks of age, it usually removes bilirubin more effectively, and the jaundice often improves on its own².

About 60% of babies born after 37 weeks of pregnancy and around 80% of babies born before 37 weeks develop jaundice during the first week after birth. In most cases, newborn jaundice is not very harmful, although it is commonly seen in many babies after birth³.

In this blog, we will understand what jaundice in newborns is, along with its causes, symptoms, treatment, and prevention. 

What Is Jaundice in Newborns?

The word “jaundice” comes from jaune, which is a French word meaning yellow. In newborn babies, jaundice refers to a yellow color that appears on the skin and the whites of the eyes. In some cases, this yellow colour may also be noticed inside the mouth or other mucous membranes. This change in colour happens when a substance called bilirubin builds up in the baby’s blood and tissues. 

Bilirubin forms when the body breaks down heme, a part of haemoglobin in red blood cells. Old or damaged cells release heme, which first turns into biliverdin and then into bilirubin. 

At this stage, the bilirubin formed is called unconjugated bilirubin. This form does not dissolve well in water, so it cannot move freely in the bloodstream. Instead, it attaches to a protein called albumin, which carries it through the blood to the liver. 

In the liver, bilirubin goes through a process called conjugation, where it is changed into a water-soluble form known as conjugated bilirubin. The liver sends conjugated bilirubin into bile, it travels through the intestines, and leaves in stool. However, a small amount may be reabsorbed in the intestine and return to the bloodstream. 

When bilirubin is not removed efficiently and begins to accumulate in the blood, it gets deposited in the skin and eyes, causing the yellow discoloration known as neonatal jaundice (jaundice in newborns)⁴.

Causes of Jaundice in Newborns

Jaundice in newborn babies can happen due to different medical conditions that increase the amount of bilirubin in the blood or reduce its removal from the body. Some of the common causes of jaundice in newborns are listed below. 

• Blood group incompatibility: This happens when the mother and baby have different blood groups, such as ABO or Rh incompatibility. The mother’s antibodies may destroy the baby’s red blood cells and increase bilirubin levels. 
• Red blood cell disorders: Some inherited conditions affect the shape or structure of red blood cells. Examples include hereditary spherocytosis and hereditary elliptocytosis, which cause red blood cells to break down faster than normal. 
• Enzyme deficiencies: Certain babies are born with enzyme problems such as G6PD deficiency or pyruvate kinase deficiency. These conditions make red blood cells fragile and cause them to break down more easily. 
• Birth-related bleeding: During delivery, some babies may develop bleeding under the scalp, such as cephalohematoma. When this collected blood breaks down, it increases bilirubin production. 
• Poor feeding or feeding difficulties: If a baby does not receive enough milk due to difficulty with breastfeeding technique or latch during the first few days, bowel movements may decrease. This slows the removal of bilirubin from the body⁴. 

These conditions increase bilirubin levels and contribute to the development of jaundice in newborn babies. 

Symptoms of Jaundice in Newborns

Jaundice in newborns is mainly noticed through changes in the baby’s skin and behaviour. It happens when bilirubin builds up in the baby’s blood. Parents and doctors often look for visible signs on the skin, eyes, and feeding pattern to identify jaundice early^4,5.

Common Symptoms of Jaundice in Newborns 

• Yellow colour of the skin, which usually starts on the baby’s face and then spreads to the chest, abdomen, legs, palms, and soles of the feet.  
• Yellowing of the whites of the eyes, or the inside of the mouth and gums⁵.
• Sleepiness or unusual drowsiness, where the baby may appear very tired^4,5.
• Poor feeding or difficulty feeding, meaning the baby may not drink enough milk. 
• Pale skin (pallor) noticed during physical examination. 
• Small red or purple spots on the skin (petechiae). 
• Bruising or swelling on the head (cephalhematoma) after birth. 
• Weight loss or signs of dehydration.  
• Changes in body movement, such as abnormal muscle tone or seizures in severe cases⁴.

If these symptoms appear, doctors may perform further tests to confirm jaundice and find the cause. Early recognition helps ensure proper care for the newborn. 

Types of Jaundice in Newborns

Jaundice in Newborns can be divided into different types based on how bilirubin is present in the baby’s body. The two main types are unconjugated hyperbilirubinemia and conjugated hyperbilirubinemia. 

Unconjugated Hyperbilirubinemia

This is the most common type of jaundice seen in newborn babies. It occurs when bilirubin has not yet been processed by the liver into a form that can dissolve in water. This type may be physiological jaundice, which is a normal condition that appears after the first day of life and usually disappears within a few weeks. It may also be pathological jaundice, which occurs when bilirubin levels rise too quickly due to conditions such as red blood cell breakdown or enzyme defects. 

Conjugated Hyperbilirubinemia

Conjugated hyperbilirubinemia occurs when bilirubin has already been processed by the liver but cannot be properly removed through bile. This may happen when there are problems affecting the liver or the bile ducts. Conditions such as infections, genetic liver diseases, or blockage of bile flow like biliary atresia can lead to this type of jaundice. This form of jaundice is usually abnormal and needs medical evaluation and treatment. 

These types of jaundice in newborns help identify what the possible cause of jaundice may be, and based on this, doctors can decide the most appropriate treatment⁴. 

Physiological vs Pathological Jaundice

Not all newborn jaundice is the same. Doctors broadly divide it into two kinds based on when it appears and what causes it, and the timing of onset is one of the most important clues¹⁵.

• Physiological jaundice is the common, harmless type. It appears after the first 24 hours of life, most often on day 2 or 3, because the newborn’s liver is still maturing and cannot remove bilirubin quickly. It usually resolves on its own within one to two weeks and does not signal any underlying disease.
• Pathological jaundice is the less common but more concerning type. It is caused by an underlying problem, such as blood group incompatibility, red blood cell disorders, infections, or bile flow blockage. A key warning sign is timing: jaundice appearing within the first 24 hours of life is always considered pathological and needs urgent medical evaluation. Jaundice that rises very fast, lasts longer than two weeks, or comes with other signs of illness may also be pathological.

Note: Any jaundice noticed in the first 24 hours of a baby’s life should be treated as a medical emergency and assessed by a doctor immediately.

How to Check for Jaundice at Home?

While only a doctor can confirm and measure jaundice, parents can do a simple visual check at home to spot early signs between medical visits.

• Check the baby in natural daylight, as artificial lighting can sometimes make yellow discoloration harder to recognise
• Gently press the skin on the baby’s forehead, nose, or chest with a fingertip.
• When you release the pressure, look for a yellow tinge on the skin where you pressed.
• Also observe the whites of the eyes, the palms, and the soles of the feet for any yellow colour.
• If the yellowing has spread to the palms and soles, or seems to be deepening, it may indicate higher bilirubin levels.

Note: This home check is only a basic observation and cannot replace a proper medical assessment. It is not a way to measure bilirubin levels. If you notice any yellowing or have any concerns about your baby, always consult a healthcare professional promptly.

Jaundice Levels in Newborns

Jaundice levels in newborns are measured by checking the amount of bilirubin in the baby’s blood. One common screening method uses a device called a transcutaneous bilirubinometer. This small device is placed on the baby’s chest or forehead and uses light to estimate bilirubin levels through the skin. The test is quick and painless but provides only an approximate result. If the reading is high, doctors confirm it with a serum bilirubin blood test, which measures the exact bilirubin level using a small blood sample taken from the baby’s heel, hand, or arm⁵.

In most newborns, bilirubin levels are about 1–3 mg/dL at birth⁶. Jaundice in newborns is generally defined when bilirubin levels rise above 5 mg/dL. In some babies, levels may increase up to 12 mg/dL, which may still occur in normal newborn jaundice. Babies with several risk factors may develop a stronger form of physiologic jaundice, where bilirubin levels may rise to 17 mg/dL⁷. 

Very high bilirubin levels can cause unconjucated bilirun to get deposited in the brain tissues leading to neurological complications, a condition known as Kernicterus. Although, it is a matter of concern when bilirubin levels exceed 25 mg/dL in healthy full-term newborns, or 20 mg/dL in babaies with haemolysis (a condition in which red blood cells break down faster than normal), doctors usually assess bilirubin levels in relation to the baby’s age in hours and clinical risk factors. Higher levels, especially if they appear early or rise quickly, may require closer monitoring or treatment⁷.

If the conjugated bilirubin level is above 1 mg/dL if total bilirubin below 5 mg/dL, or more than 20% of the total level if total bilirubin above 5mg/dl, doctors may investigate further because it can sometimes indicate liver disease or blockage of the bile ducts⁸. Additional blood or urine tests may be done if an underlying condition is suspected⁵.

Bilirubin levels are interpreted according to the baby’s age in hours, since levels normally rise during the first days after birth and gradually decrease as the liver matures. The American Academy of Paediatrics (AAP) provides hour-specific ranges divided into three risk zones: 

• Low-risk: below the 40th percentile, usually normal 
• Intermediate-risk: 40th–95th percentile, may need closer monitoring 
• High-risk: above 95th percentile, may require treatment 

Because of this, the same jaundice levels in newborns can mean different things depending on whether the baby is 24 hours old or 72 hours old. Doctors always interpret levels in the context of the baby’s exact age in hours⁷.

Kernicterus Warning Signs

Kernicterus is a rare but serious form of brain damage that can occur when bilirubin levels become extremely high and are not treated in time. Recognising the early warning signs of severe jaundice can help parents seek urgent care before complications develop¹⁶.

Seek immediate medical attention if a jaundiced baby shows any of the following:

• Excessive sleepiness or being difficult to wake.
• Difficulty feeding or refusing to feed.
• A high-pitched cry that sounds unusual.
• Reduced muscle tone, where the baby feels floppy.
• Stiffness or arching of the back and neck.
• Abnormal eye movements
• Fever.
• Seizures.

These symptoms may indicate dangerously high bilirubin levels and require emergency medical care without delay. Early treatment can prevent permanent damage, so never wait to see if these signs improve on their own.

How Long Does Jaundice in Babies Last?

Newborn jaundice is common and usually follows a predictable timeline. In the womb, unconjugated bilirubin (UCB) is cleared by the mother’s placenta, keeping foetal bilirubin low (1–3 mg/dL in cord blood). 

After birth: 

• Term babies: Bilirubin rises over the first 2–3 days, peaks around day 3–4, and usually returns to normal by day 7–10. 
• Late preterm babies: Peak occurs after 96 hours and may take longer to resolve. 
• Preterm babies (<34 weeks): Jaundice appears later, lasts longer, and may persist into the second week. 

Pathological jaundice is suspected if it appears within 24–36 hours, rises rapidly, persists >14 days, or is associated with illness, abnormal bilirubin types, or other clinical signs. Doctors evaluate timing, bilirubin levels, and risk factors to guide treatment and prevent complications⁹.

How to Treat Jaundice in Newborns?

Most newborns with jaundice do not need treatment, but if bilirubin levels become too high or rise quickly, medical care is required. Depending on the baby’s age, bilirubin level, and overall health, the treatment is decided. 

• Feeding and Hydration Support: Babies with jaundice should be fed frequently, up to 12 times a day. This helps increase bowel movements, which remove bilirubin from the body. In some cases, extra fluids may be given through a vein if needed¹. 
• Phototherapy (Light Treatment): Phototherapy is the main treatment used. The baby is placed under a special blue-green light that helps change bilirubin into a form that can be easily removed through urine and stool. The baby’s eyes are protected, and most of the body is exposed to the light. 
• Exchange Transfusion: This is used in severe cases when phototherapy does not work or bilirubin levels are very high. The baby’s blood is replaced with donor blood to quickly remove bilirubin and harmful antibodies. 
• Intravenous Immunoglobulin (IVIG): IVIG may be used when jaundice is caused by immune-related red blood cell breakdown. It helps reduce further destruction of red blood cells⁴.

The management of jaundice in newborns focus on lowering bilirubin levels safely and preventing complications while supporting the baby’s feeding and hydration. 

When Is Phototherapy Needed?

Parents often ask whether there is a single bilirubin number that decides when treatment is needed. In reality, there is no one-size-fits-all value. The level at which phototherapy is started differs from baby to baby¹⁷.

Doctors decide based on a combination of factors:

• The baby’s age in hours, since bilirubin normally rises in the first few days.
• The baby’s gestational age, as premature babies are treated at lower levels.
• The presence of risk factors, such as blood group incompatibility or red blood cell breakdown.

To make this decision accurately, doctors use age-specific bilirubin charts, such as the Bhutani nomogram and the American Academy of Pediatrics (AAP) guidelines. These charts plot the baby’s bilirubin level against their exact age in hours to see which risk zone they fall into and whether treatment is needed.

This is why the same bilirubin reading can be perfectly safe for one baby but require phototherapy in another. Always rely on your doctor’s interpretation rather than comparing numbers on your own.

Signs of Recovery from Jaundice in Newborns

As treatment begins, doctors look for certain changes that show the baby is improving and bilirubin levels are coming down. 

• Drop in bilirubin levels: Bilirubin levels start dropping quickly, especially in the first few hours of phototherapy. A steady decrease in bilirubin is seen over the first 24 hours of treatment, the biggest fall in bilirubin levels happens in the first 4 to 6 hours. Phototherapy can be stopped once bilirubin reaches a safe level. 
• The baby becomes more alert with improved appetite and feeding  
• There is an increase in wet diapers with stool frequency and colour eventually getting back to normal 
• Yellowish skin discolouration starts fading slowly over 2 to 3 weeks 

These signs together show that the baby is recovering well, even if the yellow colour takes some time to fully disappear^5,10.

How to Prevent Jaundice in Newborns?

Preventing newborn jaundice focuses on early identification of risk factors and ensuring proper care right from pregnancy and the first few days after birth. 

• Screen mothers during pregnancy: Pregnant women should be tested for blood group (ABO, Rh type) and antibodies. This helps identify risks like haemolytic disease early and prevent severe jaundice in the baby. 
• Early testing in newborns at risk: If the mother’s antibody status is unknown or positive, the baby should be tested soon after birth. This helps detect babies at risk and allows timely monitoring and treatment. 
• Ensure early and frequent feeding: Feeding should begin within the first hour after birth and continue at least 8 times a day. This improves stool passage and helps remove bilirubin from the body. 
• Provide proper breastfeeding support: Good latch and adequate milk intake are important. Monitoring urine output, stooling, and weight helps ensure the baby is feeding well. 
• Avoid unnecessary supplementation: Water or glucose water should not be given to prevent jaundice. Feeding decisions should always be made with medical advice¹¹.

Early screening, good feeding practices, and close monitoring are key to reducing the risk of jaundice and ensuring a healthy recovery for the newborn.

Breastfeeding Jaundice vs Breast-Milk Jaundice

These two conditions sound similar and are often confused, but they are different. Both are linked to breastfeeding, yet they have different causes and timing and clinical features.

• Breastfeeding jaundice occurs in the first week of life when a baby is not getting enough milk, often due to a poor latch, infrequent feeding, delayed establishment of breastfeeding, or inadequate milk intake. Less milk means fewer bowel movements, so bilirubin is not removed efficiently¹⁸.
• Breast-milk jaundice occurs in otherwise healthy, well-fed babies and tends to appear later, often after the first week. It is thought to be related to natural substances in breast milk and may last longer, sometimes for several weeks¹⁹.

In both situations, breastfeeding should usually continue unless your doctor advises otherwise. A doctor can confirm the type and rule out other causes if jaundice is prolonged.

When to Consult a Doctor?

Newborn babies should be checked by a doctor in the first few days to look for signs of jaundice and ensure safe recovery. 

• Babies discharged very early should be seen again within the first 3 to 5 days of life 
• Seek urgent care if the baby has fever, is very sleepy, or is not feeding properly 
• Contact a doctor if the yellow colour becomes deep or spreads to the legs and soles 
• Get medical advice if jaundice increases after the first visit or does not improve 
• Consult a doctor if jaundice lasts more than two weeks or other symptoms appear 

Even though jaundice is usually mild in healthy babies, timely medical checks help prevent serious complications¹.

When Should a Bilirubin Test Be Done?

A bilirubin test helps doctors measure how high a baby’s bilirubin level is and decide whether treatment or close monitoring is needed. Parents should be aware of situations where testing becomes important. A bilirubin test may be advised if²⁰:

• Jaundice appears within the first 24 hours of life.
• Jaundice is noticeable before hospital discharge or develops soon after birth. 
• The yellow colour spreads to the palms and soles.
• The baby is excessively sleepy or hard to wake.
• The baby is feeding poorly or shows the signs of dehydration.
• The baby was born prematurely.
• The jaundice appears to be worsening rapidly.
• There is a family history of severe newborn jaundice
• There is a known risk of blood group incompatibility or increased breakdown of red blood cells.
• The jaundice lasts longer than expected (more than two weeks).

Testing gives doctors a clear picture of the severity and helps them decide whether monitoring, phototherapy, or further evaluation is required. When in doubt, it is always safer to have the baby checked.

Conclusion

Jaundice in newborns is very common and mostly not serious. It happens when bilirubin builds up because the baby’s liver is still immature. It usually appears in the first few days and often goes away in 1–2 weeks. Doctors check bilirubin levels based on the baby’s age in hours. Most babies recover with feeding and phototherapy, but early detection helps prevent serious complications. 

Also Read: Rickets in Children: Causes, Symptoms, Types & Treatment 

Frequently Asked Questions (FAQs)

References

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