Newborn Jaundice: Causes, Symptoms & When to Visit the Hospital

What Is Jaundice and Why Does It Happen?

Jaundice is a yellow discolouration of the skin, the whites of the eyes and sometimes the inside of the mouth. It is caused by a build-up of bilirubin, a yellow-orange pigment produced when old red blood cells are broken down.

Newborns are especially prone to high bilirubin because:

• Before birth, babies have a high number of red blood cells, which break down quickly after birth.
• The newborn liver is immature and is not yet efficient at processing bilirubin.
• Newborns reabsorb more bilirubin from the intestines, particularly if feeding is limited.

As the liver matures and feeding improves, bilirubin is cleared in the stool and urine, and jaundice fades.

Types of Newborn Jaundice

Physiological Jaundice

The most common type. It appears on the second or third day of life, peaks around days 3 to 5 in full-term babies, and usually clears by two weeks. The baby is otherwise well, feeding and active, and typically needs no treatment or only brief phototherapy.

Breastfeeding Jaundice

Occurs in the first week when a baby does not get enough milk, because of difficulty latching or delayed milk supply, leading to dehydration and slower passage of stool. The solution is better feeding with lactation support, and does not mean stopping breastfeeding.

Breast Milk Jaundice

Appears after the first week, in an otherwise healthy, well-feeding baby, and may last several weeks. It is thought to relate to substances in breast milk that slow bilirubin processing. It is usually harmless, but any jaundice lasting more than two weeks needs a check to exclude other causes.

Pathological Jaundice

Jaundice that appears within the first 24 hours of life, rises rapidly, reaches high levels, lasts longer than two weeks or is accompanied by illness needs urgent investigation. Causes include:

• Blood group incompatibility, where the mother's antibodies attack the baby's red cells. This is seen with Rh incompatibility (Rh-negative mother, Rh-positive baby) or ABO incompatibility (mother with O group, baby with A or B).
• G6PD deficiency, an inherited enzyme deficiency that makes red cells fragile, particularly relevant in India.
• Infection (sepsis).
• Bruising or large collections of blood (cephalohematoma), since breakdown of this blood adds to bilirubin.
• Excessive red cells (polycythaemia), common in some babies.
• Hypothyroidism and metabolic conditions.
• Liver or bile duct problems, such as biliary atresia, which cause pale stools, dark urine and persistent jaundice beyond two weeks and need urgent specialist assessment.
• Prematurity, since premature babies have more immature livers and higher risk.

Risk Factors for Severe Jaundice

• Prematurity (born before 37 weeks).
• Jaundice within the first 24 hours.
• A sibling who needed treatment for jaundice.
• Blood group incompatibility between mother and baby.
• Poor feeding or weight loss of more than 10 percent of birth weight.
• Bruising or cephalohematoma from delivery.
• Exclusively breastfed babies who feed poorly.
• G6PD deficiency and family history.
• East and South Asian ancestry, which carries a higher risk of jaundice.

How to Check for Jaundice at Home

1. 1Use natural daylight, not artificial light, which can hide yellowing.
2. 2Press gently on the baby's forehead, nose or chest with a finger for a second and release. If the skin looks yellow where you pressed, jaundice may be present.
3. 3Look at the whites of the eyes and gums.
4. 4Note how far the yellowing extends. Jaundice usually starts on the face and moves downward to the chest, abdomen, legs and finally the palms and soles as bilirubin levels rise. Yellow colour on the legs, hands and feet suggests higher levels.
5. 5Check daily for the first week or two, especially after hospital discharge.

Remember, in babies with darker skin tones, yellowing can be harder to see, so check the eyes, gums and the soles of the feet. Do not rely on sunlight exposure as a treatment.

How Doctors Diagnose and Monitor Jaundice

• Visual assessment and examination of feeding, weight and behaviour.
• Transcutaneous bilirubinometer: a painless handheld device placed on the skin to estimate bilirubin.
• Serum bilirubin blood test: a small blood sample measures total and direct bilirubin and is plotted on a chart according to the baby's age in hours and risk factors to decide whether treatment is needed.
• Additional tests: blood group and Coombs test, blood count, G6PD testing, infection tests, thyroid tests and liver tests as indicated.

Treatment

Mild jaundice needs no treatment other than frequent feeding and monitoring. When bilirubin crosses the treatment threshold for the baby's age and risk, doctors may use:

Phototherapy. The baby is placed under special blue light, wearing only a diaper and eye protection. The light converts bilirubin into a form that can be excreted in the urine and stool. Phototherapy is safe and effective, and breastfeeding continues during treatment, with breaks for feeds. Most babies need it for one to three days.

Increased feeding. More frequent breastfeeds, or supplemental expressed milk or formula when medically advised, help clear bilirubin.

Intravenous immunoglobulin (IVIG). Used in certain cases of blood group incompatibility to reduce red cell breakdown.

Exchange transfusion. In rare cases of extremely high bilirubin, the baby's blood is replaced with donor blood to rapidly lower levels and prevent brain damage. It requires neonatal intensive care.

Treating the cause, such as infection or thyroid problems.

Why Severe Jaundice Is Dangerous

Very high bilirubin can cross into the brain and cause damage called kernicterus or bilirubin encephalopathy. Early signs include extreme sleepiness, poor feeding, high-pitched cry and floppiness; later, the baby may arch the back, have fever or seizures. If untreated, it can cause permanent damage including cerebral palsy, hearing loss and developmental problems. Kernicterus is entirely preventable when high bilirubin is recognised and treated in time.

When to Take Your Baby to the Hospital

Seek medical care immediately if:

• Yellow colour appears within the first 24 hours of life.
• The yellow colour spreads to the belly, arms, legs, palms or soles.
• The baby is very sleepy, difficult to wake, limp or floppy.
• The baby is feeding poorly or refusing feeds.
• The baby has a high-pitched cry, arching of the back or seizures.
• There are fewer than six wet diapers a day after the first week, or the urine is dark.
• The stools are pale, white or clay-coloured.
• The baby has fever or a low temperature.
• Jaundice lasts longer than two weeks (three weeks in premature babies).
• The baby was born prematurely, or you have a family history of severe jaundice, and you notice any yellowing.

What You Can Do at Home

• Feed frequently: breastfeed at least 8 to 12 times a day, and wake a sleepy baby for feeds. Good feeding is the most important home measure.
• Do not give water, glucose water or herbal drinks. They do not reduce jaundice and may reduce milk intake.
• Do not rely on sun exposure, which is not a safe or reliable treatment and risks sunburn or overheating.
• Do not apply oils, kajal or home remedies that might irritate the skin or delay care.
• Follow-up visits: attend your scheduled check-up within 48 to 72 hours after discharge, particularly if you left the hospital within 48 hours of birth.
• Track feeds, wet diapers and stools in a diary, and bring it to appointments.
• Seek lactation support if latching is painful or difficult.

Preventing Severe Jaundice

• Know your blood group and Rh status early in pregnancy, and ask for Rh immunoglobulin injections if you are Rh-negative.
• Plan delivery at a facility where newborn bilirubin screening and treatment are available.
• Make sure feeding is established before discharge.
• Ask for bilirubin checks, especially if the baby is premature, or you have risk factors.
• Attend follow-up, and learn how to check your baby at home.

Care at Trustmed Hospital

At Trustmed Hospital in Badshahpur, Gurugram, our paediatrics team and NICU provide bilirubin testing, phototherapy and intensive care for newborns with jaundice, with lactation support to help feeding. If you are worried about your baby's colour, call +91-8700232311 or book an appointment.

Frequently Asked Questions