Newborn Jaundice: Symptoms and Treatment

A yellow tinge to a newborn's skin or the whites of their eyes, that is noticed during the first few days at home, is one of the most common reasons new parents find themselves back at the hospital within a week of discharge. It is alarming to see. But in most cases, it is also one of the most manageable conditions of the newborn period.

Jaundice in newborn babies is extremely common. It affects around 60% of full-term newborns and up to 80% of premature babies in the first week of life. Understanding what causes it, what to watch for, and when it needs treatment takes a lot of the fear out of the situation.

What is Newborn Jaundice?

Jaundice is the yellowing of the skin and whites inside the eyes caused by a build-up of bilirubin in the blood. Bilirubin is a yellow substance produced when the RBCs (red blood cells) break down. In normal conditions, the liver processes bilirubin. It then removes it from the body through stools.

In newborns, the liver is still maturing. It cannot always process bilirubin fast enough to keep up with the amount being produced, especially in the first few days when the body is breaking down the extra red blood cells that were needed during pregnancy. Bilirubin increases in the blood and deposits in the skin, causing the yellow colour.

Newborn Jaundice Symptoms

The yellowing usually starts on the face and forehead and moves downward to the chest, abdomen, and then the arms and legs, as bilirubin levels rise.

Newborn jaundice symptoms to watch for:

• Yellow colour of the skin, starting at the face
• Yellow tinge in the whites of the eyes
• The baby seems unusually sleepy and difficult to wake for feeds
• Dark yellow or orange-coloured urine
• Pale or chalky stools

Yellowing is easier to see in natural daylight. Press gently on the tip of the nose or forehead. If the skin looks yellow when you release pressure, it is worth getting it checked. In babies with darker skin, checking the whites of the eyes and the gums is more reliable than looking at the skin alone.

Causes of Jaundice in Newborns

Not all newborn jaundice has the same cause, and the cause affects how urgently it needs to be treated.

Physiological jaundice

It is the most common type. It appears between day two and day four of life, peaks around days 3-5, and fades on its own by two weeks in full-term babies and three weeks in premature babies. It is caused by the normal breakdown of foetal red blood cells and the liver's temporary inability to keep pace.

Breastfeeding jaundice

It is sometimes called early breastfeeding jaundice. It appears in the first week when a baby is not feeding well or frequently enough, leading to low intake, less frequent stools, and therefore less bilirubin being cleared. The solution is more frequent and effective breastfeeding, and not stopping it.

Breast milk jaundice

It is different from breastfeeding jaundice. It is usually mild and resolves on its own. It appears after the first week, can persist for several weeks, and is believed to be caused by substances in some mothers' breast milk that may slow the processing of bilirubin.

Blood group incompatibility

It is when the mother and baby have incompatible blood groups (ABO or Rh incompatibility), the mother's antibodies can cross into the baby's blood and cause rapid breakdown of the baby's red blood cells. This produces jaundice that appears very early, within the first day, and rises quickly. This type needs urgent treatment.

Other causes

Infections, liver conditions, genetic disorders like G6PD deficiency, and hypothyroidism can all cause or worsen newborn jaundice.

When is Newborn Jaundice Dangerous?

Mild, resolving jaundice is not dangerous. The concern is when bilirubin levels start to rise too high.

At very high levels, bilirubin can enter the brain and cause kernicterus, a type of brain damage that affects hearing, movement, and development. Kernicterus is preventable when jaundice is identified and treated promptly. This is why newborn bilirubin levels are taken seriously.

The dangerous level varies depending on the baby's age in hours, gestational age, and risk factors. There is no single number that applies to all babies. A bilirubin level that is acceptable at 72 hours may be concerning at 24 hours. Your paediatrician will use a chart called a nomogram to decide whether treatment is needed.

As a rough guide:

• In a healthy full-term baby, bilirubin above 20 mg/dL is generally cause for treatment
• In premature or unwell babies, treatment thresholds are lower
• Jaundice appearing in the first 24 hours of life is always taken seriously regardless of level

Signs that always need same-day assessment:

• Jaundice appearing on day one of life
• Yellow colour spreading rapidly to the arms and legs
• The baby is extremely sleepy, difficult to rouse, and feeding very poorly
• Baby crying on a high-pitch
• Arched back or stiffness

Newborn Jaundice Treatment

Phototherapy

It is the main treatment for newborn jaundice. The baby is placed under special blue-spectrum lights (not sunlight) that break down bilirubin in the skin into a form the body can process and excrete more easily.

During phototherapy:

• The baby lies under the light with eyes covered to protect from the brightness
• Feeding continues regularly, every 2-3 hours, to help clear bilirubin through stools
• Bilirubin levels are checked with blood tests to monitor progress
• Most babies respond well and can go home within a day or two once levels are falling

Adequate feeding

It is both a treatment and a prevention. Frequent breastfeeding, 8-12 times in 24 hours, helps clear bilirubin through the gut. Colostrum has a laxative effect that moves meconium (the first dark stools) out, which carries bilirubin with it.

Exchange transfusion

It is used in severe cases, especially with blood group incompatibility, where bilirubin is rising very fast, and phototherapy is not keeping up. The baby's blood is partially replaced with donor blood to rapidly lower bilirubin. This is done in a neonatal intensive care unit (NICU) and is not common, but it is available in major hospitals across India.

Does Sunlight Help?

Indirect sunlight, like sitting near a window with soft morning light falling on the baby's skin, was traditionally used before phototherapy was available, and it does have a mild effect. However, it is not a reliable substitute for hospital phototherapy when bilirubin levels are elevated. Direct sunlight carries the risk of sunburn on a newborn's delicate skin and should not be used.

If the paediatrician has checked your baby and confirmed the level is mild. Monitoring is the plan, keeping the baby in a well-lit room with indirect natural light is fine as a complementary measure, not a treatment in itself.

Book an online appointment with Dr. K Shweta Reddy for Pediatric related issues.

Conclusion

Newborn jaundice is common, usually mild, and very manageable with the right care. The key is not to ignore it: check the baby in natural daylight, feed frequently, and see a paediatrician promptly if the yellowing spreads rapidly, the baby is very sleepy, or jaundice appears in the first 24 hours. Most babies treated with phototherapy recover quickly and fully.

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