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What is jaundice?

Over half of all newborns develop some amount of jaundice, a yellow coloring in their skin, during the first week. This is usually a temporary condition, but may be a more serious sign of another illness. Jaundice is caused by the breakdown of red blood cells. As the old cells are broken down, hemoglobin is changed into bilirubin and removed by the liver. The buildup of bilirubin in the blood is called hyperbilirubinemia. Because bilirubin has a pigment, or coloring, it causes a yellowing of the baby's skin and tissues. As liver function matures, the jaundice goes away. A premature infant is more likely to develop jaundice. The yellow tint to the skin can often be seen by gently pressing on the baby's forehead or chest and watching the color return.

There are several types of jaundice:

  • Physiologic jaundice Physiologic jaundice occurs as a "normal" response to the baby's limited ability to excrete bilirubin in the first days of life.

  • Breast milk jaundice About 2 percent of breast-fed babies develop jaundice after the first three to five days. It peaks about two weeks of age and can persist up to three to 12 weeks. Breast milk jaundice is thought to be caused by a maternal factor in the breast milk that increases the reabsorption of bilirubin through the intestinal tract. The process is called enterohepatic circulation.

  • Breast-feeding failure jaundice It is caused by failure to initiate breast-feeding, resulting in dehydration, decrease urine production and accumulation of bilirubin. Late preterm infants, those who are born between 34 weeks and 36 weeks, are more susceptible to this problem. They do not have the coordination and the strength to maintain a successful breast-feeding.

  • Jaundice from hemolysis Jaundice may occur with the breakdown of red blood cells due to hemolytic disease of the newborn (Rh disease), having too many red blood cells, or bleeding.

  • Jaundice related to inadequate liver function Jaundice may be related to inadequate liver function due to infection or other factors.

Why is jaundice a concern?

Although low levels of bilirubin are not usually a concern, large amounts can circulate to tissues in the brain and may cause seizures and brain damage. This is a condition called kernicterus.

What are the symptoms of jaundice?

The following are the most common symptoms of jaundice. However, each baby may experience symptoms differently. Symptoms may include:

  • Yellow coloring of the baby's skin - usually beginning on the face and moving down the body

  • Poor feeding or lethargy

Symptoms of jaundice may resemble other conditions or medical problems. Always consult your baby's physician for a diagnosis.

How is jaundice diagnosed?

The timing of the appearance of jaundice helps with the diagnosis. Jaundice appearing in the first 24 hours is quite serious and usually requires immediate treatment. When jaundice appears on the second or third day, it is usually "physiologic." However, it can be a more serious type of jaundice. When jaundice appears on the third day to the first week, it may be due to an infection. Later appearance of jaundice, in the second week, is often related to breast milk feedings, but may have other causes.

Laboratory testing for hyperbilirubinemia may include:

  • Direct and indirect bilirubin levels - These levels reflect whether the bilirubin is bound with other substances by the liver so that it can be excreted (direct), or is circulating in the blood circulation (indirect).

  • Red blood cell counts

  • Blood type and testing for Rh incompatibility (Coomb's test)

Treatment for jaundice:

Specific treatment for jaundice will be determined by your baby's physician based on:

  • Your baby's gestational age, overall health, and medical history

  • Extent of the disease

  • Your baby's tolerance for specific medications, procedures, or therapies

  • Expectations for the course of the disease

  • Your opinion or preference

Treatment depends on many factors, including the cause of the jaundice and the level of bilirubin. The goal is to keep the level of bilirubin from increasing to dangerous levels. Treatment may include:

  • Phototherapy Because bilirubin absorbs light, jaundice and increased bilirubin levels usually decrease when the baby is exposed to special blue spectrum lights. Phototherapy may take several hours to begin working and it is used throughout the day and night. The baby's position is changed to allow all of the skin to be exposed to the light. The baby's eyes must be protected and the temperature monitored during phototherapy. Blood levels of bilirubin are checked to monitor if the phototherapy is working.

  • Use of a fiber optic blanket Another form of phototherapy is a fiber optic blanket placed under the baby. This may be used alone or in combination with regular phototherapy.

  • Exchange transfusion Exchange transfusion may be used to replace the baby's damaged blood with fresh blood. This helps increase the red blood cell count and lower the levels of bilirubin. An exchange transfusion is done by alternating giving and withdrawing blood in small amounts through a vein or artery. Exchange transfusions may need to be repeated if the bilirubin levels remain high.

  • Adequate hydration with breast-feeding or pumped breast milk The American Academy of Pediatrics recommends that, if possible, breast-feeding be continued. Breast-fed babies receiving phototherapy who are dehydrated or have excessive weight loss can have supplementation with expressed breast milk or formula.

  • Treatment of underlying conditions Treating any underlying cause of hyperbilirubinemia, such as infection.

Prevention of jaundice:

While jaundice cannot be totally prevented, early recognition and treatment are important in preventing bilirubin levels from rising to dangerous levels. If your baby's color is turning more yellow, promptly call your baby's physician.