Newborn jaundice

Newborn jaundice is when your baby’s skin and the white parts of the eyes look yellow. It’s caused by the build-up of a substance in the blood called bilirubin. Newborn jaundice is very common—about 3 in 5 babies (60 percent) have jaundice.

Jaundice usually happens a few days after birth. Most of the time, it’s mild, doesn’t hurt your baby and goes away without treatment. But if a baby has severe jaundice and doesn’t get quick treatment, it can lead to brain damage.

What causes jaundice in newborns?

Your baby’s body recycles some red blood cells each day. Bilirubin is a yellow substance that forms as red blood cells break down. During pregnancy, your liver removes bilirubin for your baby. After birth, your baby’s liver may not be developed enough to properly remove bilirubin on its own. It can take a few days for your baby’s liver to be able to do this.

When a baby’s liver causes jaundice in the first days of life, it’s called benign neonatal hyperbilirubinemia. This is the most common kind of jaundice in newborns. But sometimes a health condition in your baby can cause jaundice. Babies with these health conditions are more likely to need treatment to help lower their bilirubin levels than babies with benign neonatal hyperbilirubinemia. These conditions include:

• Blood type mismatches, like Rh disease. A small number of babies have different blood types than their mothers. These mismatches can lead to a faster breakdown of red blood cells.
• Internal bleeding. This is bleeding inside the body. 
• A problem with your baby’s liver. Your baby’s liver may not work well if your baby has an infection, like hepatitis, or a disease, like cystic fibrosis; or a condition, like biliary atresia; all of these affect the liver. 
• A problem with your baby’s red blood cells. Some babies have too many red blood cells. This is more common in some twins and babies who are small for gestational age. This means a baby who is smaller than normal based on the number of weeks they’ve been in the womb. 
• A genetic condition, like G6PD deficiency. This condition is when your body doesn’t have enough G6PD, an enzyme that helps your red blood cells work the right way. 
• An infection, like sepsis. This is an infection in your baby’s blood. 
• Bruising at birth. A bruise happens when blood leaks out of a blood vessel. Sometimes babies get bruises during labor and birth. When large bruises heal, bilirubin levels may rise. 
• Untreated urinary or other infections in the mom.  Untreated infections may cause prematurity and risk for jaundice.
• Use of Sulfa drugs.  May be related to increased jaundice if given close to delivery

Some babies are more likely than others to have jaundice. These include:

• Preterm babies. A preterm baby is one who is born too early, before 37 weeks of pregnancy. A preterm baby is more likely than others to have jaundice because the liver may not be fully developed.
• Breastfed babies, especially babies who aren’t breastfeeding well. If you’re breastfeeding, feed your baby when they’re hungry. For most newborns, this is once every 2 to 3 hours (about eight to 12 times each day). Feeding this often helps keep your baby’s bilirubin level down. If you’re having trouble breastfeeding, ask your baby’s provider, a nurse or a person with special training in breastfeeding (lactation consultant) for help.
• Babies with East Asian or Mediterranean ethnic backgrounds. Ethnic background means the part of the world or the ethnic group your ancestors come from. An ethnic group is a group of people, often from the same country, who share language or culture. Ancestors are family members who lived long ago, even before your grandparents. 
• Babies who have sibling who had jaundice. If you have had other children who also had jaundice, your baby will be more likely to experience jaundice.

How do you know if your baby has jaundice?

When a baby has jaundice, a yellowish color usually first appears on the face. It then may spread to the chest, belly, arms, legs and white parts of the eyes. The best way to see jaundice is in good light, like in daylight or under fluorescent lights. Jaundice can be harder to see in babies with darker skin and looking at the eyes may give a better indication if the white area turns yellow.

Call your baby’s health care provider right away if your baby:

• Looks very yellow, orange or greenish-yellow
• The white area in the eyes looks yellow
• Is hard to wake up or won’t sleep at all
• Has trouble breastfeeding or sucking from a bottle
• Is very fussy
• Has too few wet or dirty diapers 

Call 911 or take your baby to the hospital if:

• They won’t stop crying or have a high-pitched cry
• They arch backward
• They have a stiff, limp or floppy body
• They have strange eye movements 

These may be warning signs of dangerously high levels of bilirubin that need quick treatment to prevent a kind of brain damage caused by high bilirubin levels (acute or chronic bilirubin encephalopathy (CBE)). CBE isn’t common because babies usually are treated before jaundice becomes severe. If untreated, CBE can cause:

• Athetoid cerebral palsy. Babies with this condition have uncontrollable movements in the arms, legs, face and other body parts.
• Hearing loss
• Vision problems
• Dental problems 
• Intellectual disabilities 

How are babies checked for jaundice?

The American Academy of Pediatrics (AAP) recommends that all babies be checked for jaundice after birth while in the hospital. Your baby’s provider checks her with one or more of these tests:

• Blood test. This is the best way to measure bilirubin levels. Your baby’s provider takes a small sample of blood from your baby's heel to do this test.
• Physical exam. Your baby’s provider checks your baby’s body for signs of jaundice. 
• Skin test. Your baby’s provider places a device on your baby’s forehead to check bilirubin levels. The device measures the reflection of a special light that shines through the skin.

The AAP recommends that babies be checked for jaundice again at 3 to 5 days of age. This is the time when bilirubin levels are the highest. If your baby leaves the hospital before 72 hours (3 days) of age, your baby should be checked within the next 2 days.

How is jaundice treated?

Most babies with jaundice don’t need treatment. If your baby has mild jaundice, her provider may recommend that you breastfeed your baby more often so to produce more bowel movements. This helps to get rid of bilirubin.

Jaundice usually clears up within 2 weeks in formula-fed babies. It may last for more than 2 to 3 weeks in breastfed babies. If your baby’s jaundice lasts more than 3 weeks, talk to your baby’s health care provider.

Babies with more severe jaundice may need treatment including:

• Phototherapy treatment (also called light therapy or bili lights). This is when your baby is placed under special lights that help your baby’s body change bilirubin into a form that can exit the body in urine. While your baby is under the lights, they wear just a diaper and shields over the eyes. Some babies can lie on a light therapy blanket (also called a fiberoptic blanket) that has tiny bright lights in it. You may use the blanket in place of, or along with, the overhead lights. If you can’t afford to have your baby treated with the special lights or blanket, your doctor may use indirect (filtered) sunlight to treat your baby’s jaundice. This kind of sunlight removes the rays that could burn your baby’s skin, so it is safer than direct sunlight. Phototherapy can be done in the hospital or at home, and it’s safe for your baby.
• Intravenous immunoglobulin (also called IVIg). If you and your baby have different blood types, your baby may get immunoglobulin (a blood protein) through a needle into a vein. This can help treat the jaundice so that your baby is less likely to need an exchange transfusion.
• Exchange transfusion. If phototherapy doesn’t work and your baby’s bilirubin levels are still very high, your baby may need a special type of blood transfusion called an exchange transfusion. An exchange transfusion gets rid of bilirubin by replacing your baby’s blood with fresh blood in small amounts. This type of therapy is very expensive and is only used when a baby who has complications like CBE.

See also: Preterm babies

Last reviewed: January 2024