Jaundice is the yellowish discoloration of the skin, mucous membranes and
the whites of the eyes (sclerae) caused by elevated levels of bilirubin in the
blood (hyperbilirubinemia). The term jaundice is derived from the French word
jaune, which means yellow.
Jaundice is not technically a disease, but
rather it is a visible sign of an underlying condition causing increased levels
of bilirubin in the blood.
Jaundice in newborns (neonatal jaundice)
Neonatal jaundice is the most common condition requiring medical evaluation
in a newborn. Though it is often a normal and transient physiologic
consequence of the newborn's immature liver, there are a variety of other
medical conditions which can cause severe neonatal jaundice. Jaundice in the
newborn must be carefully monitored, as excessively elevated levels of bilirubin
that go untreated for too long, can lead to permanent brain damage (a condition
What causes jaundice in newborns?
Jaundice is caused by the accumulation of bilirubin in the blood, typically
from an increased production of bilirubin or a decreased ability to metabolize
and excrete it. Bilirubin is formed when red blood cells break down and is
normally metabolized in the liver and excreted in urine and feces.
Neonatal jaundice can be caused by several different conditions, and it is
very commonly seen in newborns. The most common cause in newborns is physiologic
jaundice, which affects most newborns and is usually benign. However,
there are many other causes of neonatal jaundice that can be more serious, and
require further medical evaluation and intervention. A newborn that develops jaundice within the first 24 hours of life requires immediate medical attention. The following are some
of the causes of neonatal jaundice.
Newborn Jaundice Symptoms and Signs
What are the signs and symptoms of jaundice in newborns?
Jaundice usually appears first on the face and then moves to the chest, belly, arms, and legs as bilirubin levels get higher. The whites of the eyes can also look yellow. Jaundice can be harder to see in babies with darker skin color. The baby's doctor or nurse can test how much bilirubin is in the baby's blood.
This form of jaundice is usually evident on the second or third day of life.
It is the most common cause of newborn jaundice and it is usually a transient
and harmless condition. Physiologic jaundice is caused by the inability of the
newborn's immature liver to metabolize (conjugate) and thus excrete bilirubin,
which accumulates due to the breakdown of red blood cells which have a shorter
life-span (70 to 90 days) than adult red blood cells (120 days). This increase in
red blood cell breakdown and decreased ability to metabolize bilirubin
overwhelms the newborns ability to properly process and excrete bilirubin. As
the newborn's liver matures, however, the jaundice eventually disappears after
1 to 2 weeks.
Maternal-fetal blood group incompatibility (Rh, ABO)
This form of jaundice occurs when there is incompatibility between the blood
types of the mother and the fetus. This leads to increased bilirubin levels from
the breakdown of the fetus' red blood cells (hemolysis).
Breast milk jaundice
This form of jaundice occurs in breastfed newborns and often appears at the
end of the first week of life. Certain chemicals in breast milk are thought to
be responsible. It is usually a harmless condition that resolves spontaneously.
Mothers typically do not have to discontinue breastfeeding.
This form of jaundice occurs when the
breastfed newborn does NOT receive
adequate breast milk intake. This may occur because of delayed or insufficient
milk production by the mother or because of poor feeding by the newborn. This
inadequate intake results in dehydration and
fewer bowel movements for the newborn, which results in decreased bilirubin
excretion from the body.
Cephalohematoma (a collection of blood under the scalp)
Sometimes during the birthing process, the newborn may sustain a
injury to the head, resulting in a blood collection/blood
clot under the scalp. As this blood is naturally broken down, sudden
elevated levels of bilirubin may overwhelm the processing capability of the
newborn's immature liver, resulting in jaundice.
Red blood cell enzyme defects
Inherited genetic enzyme disorders, such as
deficiency (G6PD deficiency) or pyruvate kinase deficiency, for example, can lead to increased
hemolysis and subsequent elevation in bilirubin levels.
Red blood cell membrane defects
Abnormalities in the membrane and shape of red blood cells (for example,
spherocytosis) can lead to increased hemolysis.
Other causes of neonatal jaundice include prematurity,
polycythemia, infection/sepsis, hypothyroidism, biliary atresia,
fibrosis, Crigler-Najjar syndrome, Gilbert syndrome, hepatitis,
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What are the
symptoms of jaundice in newborns?
Neonatal jaundice may be associated with various symptoms, depending upon the
degree of elevation in bilirubin levels as well as the exact cause of the
jaundice. The yellow discoloration of the skin will begin on the face and
forehead and extend toward the feet as the levels of bilirubin increase. This
characteristic progression of jaundice in infants can sometimes allow your
health care professional to estimate the bilirubin level based on the location and
extent of the jaundice, though this assessment can often be inaccurate.
The signs and symptoms associated with neonatal jaundice may include the
- Yellow discoloration of the skin, mucous membranes and the whites of the
- Poor feeding
- Lethargy/excessive sleepiness
- Changes in muscle tone (either listless or stiff with arching of the
- High-pitched crying
Kernicterus, which is caused by prolonged excessively elevated levels of
bilirubin affecting the central nervous system, must be recognized and promptly
treated as it can lead to permanent brain damage. Kernicterus is an irreversible
and chronic condition which can include cerebral palsy, hearing loss, and
intellectual impairment. Kernicterus has likely started to develop if the infant
begins to exhibit extreme lethargy, changes in muscle tone, and a high-pitched
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What are the risk factors for jaundice in newborns?
Approximately 60% of all newborns develop jaundice; however newborns with
certain risk factors are at higher risk for developing neonatal jaundice. Risks
factors include the following:
- Having siblings who have had neonatal jaundice
- Having parents of East Asian or Mediterranean descent
- Preterm babies
- Newborns with feeding difficulties/poor feeding
- Mother with diabetes
- Newborns with bruising/cephalohematoma
- Blood type incompatibility
- Congenital infection
How is jaundice in newborns diagnosed?
Neonatal jaundice can be diagnosed by examining the newborn and obtaining a
blood test to check the total serum bilirubin level. Your health care
should closely follow your newborn for the development of jaundice, and many
hospitals routinely check total bilirubin levels on newborns prior to hospital
discharge. Though the blood test is the most accurate, in certain instances, a
transcutaneous bilirubin reading can be obtained by placing a handheld sensor
against the newborns skin. If this reading is high, a blood test may be ordered
to confirm the total bilirubin level. Bilirubin levels are usually highest at
3 of 5 days of life. Additional blood tests may be ordered for those newborns who
require treatment and monitoring, or for those who may have other underlying
conditions thought to be causing neonatal jaundice.
What is the treatment for jaundice in newborns?
The need to treat jaundice in newborns is determined by interpreting the
total bilirubin level in relation to the newborns age in hours. If the level is
deemed to be too high, or if it is rising too quickly, treatment is necessary.
Sometimes, all that is needed for treatment is close monitoring of the bilirubin
levels, and no further interventions may be necessary. In certain instances,
treatment for neonatal jaundice can occur at home, while in other cases,
admission to a hospital is necessary.
Based on the total bilirubin level, the underlying cause leading to jaundice,
and the newborns clinical condition, various treatment modalities are available
to treat jaundice in newborns. These include the following:
- Feeding/hydration: By encouraging frequent
feeding with breast milk or formula, newborns will produce more stool and urine,
and thus eliminate bilirubin more rapidly from the body. Newborns may need to be
fed up to 12 times per day, thus ensuring proper hydration and elimination. In
certain instances, newborns may require observation in a hospital to receive
intravenous fluids and closer monitoring of bilirubin levels.
- Phototherapy: This treatment is the most common
for newborns requiring medical treatment for neonatal jaundice. Phototherapy
(light treatment) involves placing the newborn under artificial blue lights with
the baby undressed (wearing only a diaper) and using a special mask to protect
the eyes. This treatment may occur in an open bassinet or warmer, or sometimes
with a phototherapy blanket. These special lights work by converting bilirubin
to lumirubin through a chemical reaction that occurs when the newborns skin is
exposed to these special lights. This allows the newborn to more easily
eliminate bilirubin from the body. Care needs to be taken to avoid excessive
heat and dehydration. Phototherapy is used in hospitals, and in certain cases,
newborns may be treated at home with phototherapy. Generally speaking,
phototherapy is very safe and effective, and this treatment is successful for
almost all newborns who require it. Phototherapy treatment is stopped once the
newborns closely monitored bilirubin levels have decreased to appropriate
- Exchange transfusion: This urgent treatment is
used in newborns with severe jaundice who may have failed phototherapy treatment
or in those who are at higher risk of developing or have signs of kernicterus.
During an exchange transfusion, the newborns blood is replaced with donated
blood to rapidly decrease bilirubin levels. It is a more specialized procedure
that is used on a case-by-case basis.
- Intravenous immunoglobulin: Administering this
treatment may be used in select cases of significant neonatal jaundice due to
maternal-fetal blood group incompatibility, and it may in some cases reduce the
need for an exchange transfusion.
What are the complications of jaundice in newborns?
The complications associated with neonatal jaundice occur when bilirubin
levels reach toxic levels, and the bilirubin gets into the central nervous
system and damages the brain. The brain toxicity can either be reversible (early
acute bilirubin encephalopathy) or the damage may be permanent and irreversible
(kernicterus). Permanent damage may lead to cerebral palsy, deafness, and
Can jaundice in newborns be prevented?
Some degree of jaundice in newborns is normal and not entirely preventable.
However, the prevention of significant hyperbilirubinemia and its complications
is possible through proper screening (obtaining bilirubin levels), identifying
newborns at high-risk, close surveillance and monitoring of those infants with
hyperbilirubinemia, parent education, and prompt treatment when deemed medically
What is the prognosis of jaundice in newborns?
Generally speaking, the prognosis for newborns with jaundice is excellent if
they receive the appropriate monitoring and treatment, and the vast majority of
infants with neonatal jaundice will improve with no adverse effects. However,
health care professionals need to remain vigilant and parents need be informed and
educated about the potential dangers of severe hyperbilirubinemia in order to
prevent the devastating consequences of kernicterus.
Medically reviewed by Margaret Walsh, MD; American Board of Pediatrics
CDC.gov.Jaundice and Kernicterus.
"Neonatal Jaundice." MedscapeReference.com. Updated Mar. 4, 2016.