Newborn Jaundice: A Guide For Parents

Jaundice is a common condition in newborns, typically appearing within the first few days of life. It results from an excess of bilirubin, a yellow pigment produced during the normal breakdown of red blood cells. Although jaundice often resolves on its own, it can require medical intervention to prevent serious complications. This article helps new parents understand the causes, symptoms, and testing and treatment options for newborn jaundice. This article also shares important information on when to contact a doctor for jaundice. 

What Is Newborn Jaundice?

Newborn jaundice occurs when a baby’s liver is not able to efficiently remove bilirubin from the blood, leading to its buildup in the body which causes the skin and eyes to appear yellow (1). Jaundice is more common in premature infants, babies with bruising during birth, or those born to mothers with certain medical conditions (1). In most cases, newborn jaundice is mild and resolves with minimal intervention, but it can sometimes lead to more serious health complications if left untreated (1).

What Is Bilirubin?

Bilirubin is a yellow compound that forms as a byproduct when red blood cells break down (1). It plays a key role in the body’s natural recycling process. When old or damaged red blood cells are broken down, bilirubin is produced and transported to the liver. The liver processes the bilirubin, converting it into a form that can be excreted through stool and urine (1). This is an essential part of the body’s waste removal system, helping to eliminate old red blood cells and maintain healthy blood cell balance.

Differences In Newborn Bilirubin Levels

In newborns, the process is slightly different due to their unique physiology. Newborns are born with a higher number of red blood cells, which are rapidly replaced after birth as part of their natural development (1). This leads to an increased production of bilirubin. At the same time, newborn livers are still immature and not yet fully efficient at processing and excreting bilirubin. This combination of higher bilirubin production and the slower breakdown of bilirubin can result in benign physiologic jaundice, especially in premature babies whose livers are further behind in development. 

Additionally, newborn jaundice can also be caused by more serious issues affecting red blood cell breakdown or bilirubin processing or elimination as described below. 

What Causes Newborn Jaundice?

In the case of physiologic jaundice, which is the most common form of newborn jaundice, the cause has to do with the newborn’s liver that is still maturing and is not yet efficient at processing bilirubin. As such, physiologic jaundice typically resolves on its own within 1-2 weeks as the baby’s liver matures and bilirubin levels naturally decline (3).

Other factors that can contribute to or increase the likelihood of jaundice include:

• Prematurity: Premature infants have underdeveloped livers, making it harder for them to process bilirubin (1).
• Blood Incompatibility: If the mother’s and baby’s blood types are incompatible, the baby’s red blood cells may break down more quickly, releasing more bilirubin into the bloodstream (3). To learn more about this, read this article: Understanding the RhoGAM Shot: A Guide for Expectant Mothers
• Breastfeeding Challenges: Issues with breastfeeding, such as poor latch or insufficient milk intake, can lead to dehydration or fewer bowel movements, slowing bilirubin excretion (3).
• Excessive Bruising During Birth: Babies who experience trauma during delivery may have more red blood cells to break down, increasing bilirubin levels (1).
• Medical Conditions: Blood clotting disorders or other conditions affecting red blood cell breakdown can also cause elevated bilirubin levels (1).

Types of Jaundice

There are five different types of jaundice that affect newborns, each with unique considerations (2).

1. Physiologic Jaundice 

Physiologic jaundice is the most common form of jaundice, seen in about 60% of full-term newborns (3). It usually appears between the second and third day of life and resolves on its own within two weeks as the baby’s liver matures (2).

2. Breastfeeding Jaundice 

Breastfeeding jaundice occurs in the first week of life in breastfed babies and is linked to insufficient breastfeeding, which in turn leads to dehydration or reduced bowel movements, which slows down bilirubin excretion (2). Working with a lactation consultant to resolve feeding issues and encouraging more frequent breastfeeding can help reduce bilirubin levels.

For tips related to breast milk supply, read this article: 12 Ways To Increase Breast Milk Production

3. Breast Milk Jaundice 

Breast milk jaundice is different from breastfeeding jaundice. Breast milk jaundice usually appears later, typically in the second week of life. This type of jaundice is linked to substances that are naturally present in breast milk (2) (more so in the breast milk of some mothers than others likely due to genetics) that may slow down the liver’s ability to process bilirubin (3). This condition is usually harmless and resolves without intervention over time.

4. Pathologic Jaundice 

Pathologic jaundice is less common than the other types of jaundice but more serious. It can occur within the first 24 hours of birth and is usually due to underlying conditions, such as blood type incompatibilities, liver diseases, or genetic disorders (3). In these cases, bilirubin levels rise rapidly and require prompt medical attention.

5. Hemolytic Jaundice 

Hemolytic jaundice is associated with conditions that cause rapid breakdown of red blood cells, such as Rh incompatibility between the mother and baby (3). Hemolytic jaundice can lead to more severe and rapid rises in bilirubin levels and often requires prompt treatment.

Symptoms of Newborn Jaundice

Recognizing the symptoms of jaundice early is key to getting your newborn proper care. Symptoms of newborn jaundice can include:

• Yellowing of the Skin and Eyes: Jaundice typically begins on the face and then spreads to the chest, abdomen, arms, and legs. You can check for yellowing by pressing one finger on a baby’s forehead or nose (called “blanching” the skin). If the skin is jaundiced, it will appear yellow when the finger is removed. You can also do this by pressing on bony areas of their chest, hips, and knees to check if the jaundice is progressing down their body (1). Yellowing of the skin may be harder to detect in babies with darker skin tones. Regardless of skin tone, the eyes are often one of the first areas where yellowing can be noticed.
• Sleepiness: Babies with high bilirubin levels may be less active and more sleepy than usual. If you cannot keep your baby awake to feed, contact your doctor. Severe lethargy in a newborn is an emergency. 
• Dark Urine: In severe cases, urine may appear darker than usual. This requires an immediate call to your doctor.
• Pale or Light-Colored Stools: Normal newborn stool is mustard yellow. Pale or white stools may indicate a liver problem and require prompt medical care.

FAQ: Does the Vitamin K1 Shot Cause or Worsen Jaundice?

Historically, there have been concerns regarding the possibility of the vitamin K shot increasing the risk of jaundice, especially when large doses of synthetic Vitamin K were used (2). However, the form and dosage of vitamin K given to newborns today have not been found to contribute to jaundice (3).

For context, the dose that is normally given to infants is 0.5-1 mg of vitamin K1; this is much lower than the doses that were shown to cause high levels of bilirubin and jaundice which were around 25-30 mg (3). 

To learn more about the Vitamin K1 shot for newborns, read this article: Why Infants Get Vitamin K1 At Birth

FAQ: Is Newborn Jaundice Harmful?

In most cases, newborn jaundice is mild and resolves without treatment provided that the underlying cause is properly addressed. However, when bilirubin levels become too high (greater than 25 mg/dL), it can lead to serious complications, including:

• Kernicterus: A form of brain damage caused by very high bilirubin levels. It can lead to lifelong issues such as cerebral palsy, hearing loss, and intellectual disabilities (4).
• Deafness: Excessive bilirubin can damage parts of the brain responsible for hearing (1).

Because of these risks, it’s important to let your doctor know if you suspect jaundice right away and for them to monitor jaundice appropriately.

Testing Bilirubin Levels: When Does My Baby Require Treatment?

The need for treatment depends on the baby’s bilirubin levels and age. There are two main ways to test bilirubin levels:

1. Transcutaneous Bilirubin Meter (TcB): This is a non-invasive device that measures bilirubin by shining a light on your baby’s skin. It is typically used in the hospital or during routine pediatric visits (1).
2. Serum Bilirubin Test (SBR): If a TcB reading shows higher bilirubin levels or your doctor is concerned, they may order a blood test (serum bilirubin) to get a more precise measurement. This test involves drawing a small amount of blood from your baby’s heel to assess bilirubin levels more accurately (1).

In general, the following levels of bilirubin may require medical intervention in a full-term, healthy newborn (5):

• Above 10 mg/dL: Less than 24 hours old
• Above 15 mg/dL: 24-48 hours old
• Above 18 mg/dL: 49-72 hours old
• Above 20 mg/dL: Older than 72 hours

If your baby has elevated bilirubin levels, your pediatrician will likely recommend continued frequent blood testing until the elevated levels resolve, as well as some home care measures.

Home Care Tips for Mild Jaundice

For most newborns, mild jaundice under the levels listed above can be managed at home with simple interventions. Here are some tips to support your baby’s recovery:

1. Increase Feeding Frequency: Whether breastfeeding or formula-feeding, increasing feeding frequency helps boost stool and urine production, which aids in bilirubin excretion. Aim to feed your newborn 8 to 12 times per day during the first few days of life.
2. Supplement with Formula, Expressed Breast Milk, or Donor Milk: In some cases of breastfeeding jaundice or if a baby is not feeding effectively, supplementing with formula, expressed breast milk, or donor milk may be recommended to ensure the baby is receiving adequate nutrition and hydration. This can help increase bowel movements and aid in flushing bilirubin from the system. Supplementation can be temporary while ensuring that breastfeeding is supported and continued as the primary feeding method.
3. Expose Baby to Sunlight: Sunlight helps break down bilirubin in the skin. If possible, place your baby near a sunny window for 5-10 minutes a few times a day. Note that infant skin burns easily – filtered sunlight is preferred – no need to place your baby in direct sunlight.
4. Monitor Hydration: Keep track of your baby’s hydration through wet diapers and bowel movements. Dehydration can exacerbate jaundice, so ensure your baby is feeding well and staying hydrated.
5. Use Home Phototherapy: If your baby’s bilirubin levels are elevated but not critical, your doctor may prescribe bili lights or a bili blanket for use at home. These portable phototherapy devices help break down bilirubin in your baby’s skin, and they allow for treatment without hospitalization (5). Your doctor will give you specific instructions on how long and how often to use the lights.

If you are treating your baby for mild jaundice at home, it is important to keep an eye on any changes in your baby’s skin tone, activity levels, and feeding habits. Your doctor will likely want to continue to check your baby’s serum bilirubin levels regularly until the jaundice resolves. If jaundice appears to worsen or your baby is excessively sleepy and difficult to wake, contact your healthcare provider.

Hospitalization for Newborn Jaundice

If bilirubin levels are very high or rising rapidly, hospitalization may be necessary for more intensive therapy and continued monitoring. Treatment may involve the following:

Delayed Discharge

In cases where jaundice develops early or bilirubin levels are rising immediately following birth, your healthcare team may recommend delaying discharge from the hospital. This allows for closer monitoring and treatment before jaundice becomes severe. Delayed discharge is common if there are additional risk factors, such as prematurity, significant bruising, or blood type incompatibilities.

In-Hospital Phototherapy 

While phototherapy can often be performed at home, for premature infants or more severe cases, your pediatrician may recommend in-hospital phototherapy. Your baby will be placed under a special light that helps break down bilirubin in the skin. 

IV Fluids 

Intravenous fluids may be given in hospital to help flush bilirubin out of your baby’s body, especially if your baby is dehydrated or has trouble feeding (6).

Exchange Transfusion 

In rare severe cases, your baby may need an exchange transfusion, where their blood is replaced with fresh blood to quickly lower bilirubin levels (6).

When to Seek Medical Attention

Most cases of jaundice are harmless and resolve on their own, but there are certain signs that require immediate medical attention:

• Jaundice Appears Within the First 24 Hours: Jaundice occurring within the first day of life is a red flag and requires prompt evaluation (4).
• Yellowing Spreads Beyond the Face and Chest: If jaundice spreads to the arms and legs or intensifies, it could indicate higher bilirubin levels (1).
• Baby Becomes Extremely Lethargic: Excessive sleepiness or difficulty waking your baby for feedings may be a sign of dangerously high bilirubin levels and requires prompt medical attention.
• Feeding Issues: If your baby is having trouble feeding or not feeding enough, contact your healthcare provider.
• Signs of Dehydration: Dehydration is very dangerous in a newborn. Fewer wet diapers, dark urine, or a dry mouth can indicate dehydration.

To learn more about newborn care, read these articles: The Benefits of Newborn Skin-to-Skin Contact, Understanding Newborn Antibiotic Eye Ointment and All About Vernix: Should It Be Washed Off?

Summary

Newborn jaundice is a common condition caused by excess bilirubin in the blood that results in yellowing of the skin and eyes. It typically appears within the first few days of life and is usually mild, resolving on its own as the baby’s liver matures. However, if bilirubin levels rise too high, some cases may require medical attention to prevent potential complications, like brain damage or hearing loss. Types of jaundice include physiologic, breastfeeding, breast milk, hemolytic, and pathologic, each with unique causes and considerations. Treatment ranges from frequent feedings and phototherapy to hospitalization and exchange transfusions in more severe cases. Parents should monitor their baby’s symptoms and seek immediate medical attention if the yellowing gets worse or if their baby becomes excessively lethargic.

References:

1. Wong, R. J., & Bhutani V. K. (2019). Patient education: Jaundice in newborn infants (Beyond the Basics). Uptodate.com. https://www.uptodate.com/contents/jaundice-in-newborn-infants-beyond-the-basics/print
2. Bratton, S., Cantu, R. M., & Stern, M. (2023, January 17). Breast Milk Jaundice. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK537334/
3. Stanford Medicine – Newborn Nursery. (2006). Guidelines for Vitamin K Prophylaxis. https://med.stanford.edu/newborns/clinical-guidelines/vitamink.html
4. Ullah, S., Rahman, K., & Hedayati, M. (2016). Hyperbilirubinemia in Neonates: Types, Causes, Clinical Examinations, Preventive Measures and Treatments: A Narrative Review Article. Iranian journal of public health, 45(5), 558–568.
5. American Pregnancy Association. (2012, April 25). Newborn Jaundice. https://americanpregnancy.org/healthy-pregnancy/first-year-of-life/newborn-jaundice/
6. Ansong-Assoku, B., Shah, S. D., Adnan, M., et al. Neonatal Jaundice. (Updated 2024 Feb 12). Treasure Island (FL): StatPearls Publishing; 2024 Jan-. https://www.ncbi.nlm.nih.gov/books/NBK532930/