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Jaundice

Image Copyright © 2014 Dr P. Marazzi / Science Source. All Rights Reserved.
Photo credit: Dr. P. Marazzi / Science Source

What is jaundice?

Jaundice happens when too much of a natural chemical called bilirubin builds up in your baby's body. Jaundice usually appears two or three days after birth (NHS 2015).

Bilirubin is made when red blood cells reach the end of their life and break down. Newborns tend to have high levels of bilirubin because they have extra red blood cells (NHS 2015, NICE 2010a). As well as this, their young livers are less efficient at processing bilirubin. It's all part of adjusting to life outside the womb (uterus) (LLL GB nd).

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If your baby has white skin, jaundice will make their skin look yellow. If your baby has black or brown skin, the yellowness will show more clearly in the whites of their eyes and on their palms and soles of their feet (NHS 2015).

As bilirubin levels rise above normal, the yellowness of jaundice moves downwards from your baby's head and face, before spreading to their chest and tummy (NHS 2015, Wong and Bhutani 2017). For some babies, the yellowness reaches their arms and legs (NHS 2015, Wong and Bhutani 2017).

Jaundice affects more than half of all healthy babies in the first week of life (NHS 2015). It is even more common among premature babies (NHS 2015, NICE 2010b).

As long as your baby is otherwise healthy, jaundice won't harm them and will go away within a week or two (NHS 2015, NICE 2010a). By the time your baby is two weeks old, their liver is better able to process bilirubin, so jaundice goes (Wong and Bhutan 2017).

How can I tell if my baby has jaundice?

In a well-lit room, gently press your fingers on your baby's nose or forehead. If there's a yellow tinge to their skin as the pressure is released, tell your midwife or doctor (NHS 2015, NICE 2010a, 2015). If your baby has dark skin, check for yellowness in the whites of their eyes or gums (NHS 2015, NICE 2010a).

Another way you can tell if your baby has jaundice is by comparing the colour of the back of their hands with the colour of their face (D Parry 2021, personal communication, 06 May).

You may also notice that your baby:

  • Is sleepy and floppy, and doesn't feed well (NHS 2015).
  • Has a higher-pitched cry than other babies (NHS 2015).
  • Does dark yellow wees and pale poos. Healthy wee is colourless to pale yellow and normal baby poos are yellow or orange (NHS 2015, NICE 2010a). Jaundiced babies' poo is pale because not much bilirubin reaches the digestive system (NHS 2015, NICE 2010a).
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Always tell your midwife, health visitor or doctor if your baby has jaundice. They will check your baby's overall health and advise you whether they need treatment.

Is my baby likely to get jaundice?

Your baby is more likely to develop jaundice if:

  • They were premature (NICE 2010a, b).
  • They have an older brother or sister who needed treating for jaundice (NICE 2010a, b).
  • You had an assisted birth with ventouse or forceps, as babies with bruising are more likely to get jaundice (NICE 2015).
  • You opted for delayed cord clamping. Your baby benefits from having extra placental blood, but it does mean they'll have more blood cells to break down (McDonald et al 2013).

Breastfeeding your baby exclusively can increase their chances of developing jaundice (NHS 2015). To help clear the jaundice, breastfeed them often (NICE 2010b). The advice to breastfeed your baby as much as possible may sound confusing, but it does help to clear jaundice. The more your baby feeds, the more often they'll poo. Each time your baby poos, they get rid of a bit more bilirubin from their body (LLL GB nd).

Your baby may poo each time you breastfeed them in the early weeks (NHS Inform 2018). You may need to wake your baby to feed them frequently if they are very sleepy (NHS 2015, NICE 2010a, b).

Massaging your baby’s tummy every day, in a clockwise circular motion, can help move your baby's poo through her system, and so help the jaundice to clear (Cleveland et al 2017, Eghbalian et al 2017).
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You don't need to give your baby formula milk or water instead of breastmilk (NICE 2010b, 2013). Breastmilk is best for your baby, for many reasons (Horta and Victora 2013).

Is jaundice serious?

Jaundice on its own is very rarely serious. It usually starts a couple of days after birth and clears up without any treatment within a couple of weeks (NHS 2015). However, occasionally, jaundice can be a sign of another illness, and this can be signalled if the jaundice doesn't follow the usual pattern.

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Call your doctor if:

  • your baby becomes jaundiced within 24 hours of birth
  • your baby becomes jaundiced for the first time when they're more than seven days old
  • your baby's jaundice lasts for more than 21 days if your baby was premature
  • your baby's jaundice lasts for more than 14 days if your baby was full term (NHS 2015, NICE 2010b, NICE 2015)

The following underlying conditions can cause jaundice:

  • An underactive thyroid gland (hypothyroidism), where the thyroid gland doesn't produce enough hormones (NHS 2015).
  • Incompatible blood groups between a mum and their baby. These different blood types may have mixed during the pregnancy or birth. For example, if the mum has rhesus-negative blood and the baby has rhesus-positive blood (NHS 2015).
  • A urinary tract infection (UTI) (NHS 2015).
  • A blockage or problem in the bile ducts and gallbladder. These organs create and transport bile, which helps to digest fats (NHS 2015).
  • An inherited enzyme deficiency called glucose 6 phosphate dehydrogenase (G6PD) deficiency. G6PD deficiency is more common in people of African, Asian or Mediterranean descent. If you have a family history of G6PD deficiency, tell your midwife or doctor so they can monitor your baby's symptoms closely (NHS 2015, Rull 2014).

There is also an extremely rare complication of untreated newborn jaundice called kernicterus (NHS 2015). Kernicterus only affects one baby in 100,000. It can cause long-term problems, such as cerebral palsy, hearing loss, learning difficulties, and eye and tooth problems (NHS 2015, NICE 2015). As well as severe jaundice, kernicterus causes a baby to feed very poorly and go floppy, like a rag doll (NHS 2015).

How will I know if my baby needs treatment for jaundice?

Whether or not your baby needs hospital treatment will depend on their bilirubin levels. Your doctor can check their bilirubin levels in two ways:

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  • Using a small device called a bilirubinometer. This beams light on to your baby's skin. It works out how much bilirubin is in their body by checking how the light bounces off or is absorbed by their skin.
  • By taking a small blood sample via a heel prick test. It's only a small, quick prick, so it shouldn't upset your baby too much. The level of bilirubin in the blood can then be measured (NHS 2015, NICE 2010a).

Usually, a bilirubinometer will give all the information your doctor needs to decide treatment, if any.

Your baby should only need a blood test if:

  • they were born prematurely
  • they've developed jaundice within their first 24 hours of birth
  • their bilirubin levels are especially high (NHS 2015, NICE 2010a).

What counts as a normal bilirubin level depends on how old your baby is. If your baby was born at or after 38 weeks, the table below shows the maximum safe bilirubin level. If your baby’s bilirubin measurement is higher than the maximum safe level, your doctor should offer you treatment.

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Your baby’s age in hoursNormal bilirubin level - at
or below (micromol/litre)
0100
6125
12150
18175
24200
30212
36225
42237
48250
54262
60275
66287
72300
78312
84325
90337
96+350
(NICE 2016)

If your baby’s bilirubin levels are rising, or already high, they may need treatment in hospital, possibly in a special care baby unit (NHS 2015, NICE 2010a, b). There are different levels of treatment, depending on how jaundiced your baby is:

Conventional phototherapy

Your baby will lie on a bed under a light that emits rays at a certain wavelength. The light helps to break down the excess bilirubin so that their liver can get rid of it. It's not like sunlight, so it won't burn their skin, but they may develop a temporary and harmless rash afterwards (Wong and Bhutani 2017).

A nurse will put special glasses or goggles on your baby to protect their eyes (NICE 2010a).

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Phototherapy is a very safe treatment, but it may make your baby warm and dehydrated. Hospital staff check your baby's temperature during the treatment (Wong and Bhutani 2017) and will stop it every three or four hours to give them a break.

Each break usually lasts about half an hour, and it's a chance for you to feed and cuddle your baby, and change their nappy (NICE 2010a). Your doctor or nurse may check your baby's nappies for signs of dehydration (Wong and Bhutani 2017).

Breastfeeding your baby at breaks in the treatment is the best way to keep them hydrated, and hospital staff should support you to do this (NICE 2010a).

However, if your doctor is concerned your baby is becoming dehydrated they may ask to give your baby extra fluids via a drip. Most of the time, babies having phototherapy don't need this (NICE 2010a).

Intensified phototherapy

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If your baby's jaundice doesn’t improve quickly enough your doctor will recommend intensified phototherapy. This involves continuous phototherapy, with no breaks for feeding. It uses a stronger light source, or more than one light source (NICE 2010a).

Your baby will need feeding through a very fine, soft tube that the doctor will pass through her nose and into her tummy. Ideally, you'll be able to express enough milk to keep your baby going through the treatment (NHS 2015, NICE 2010a).

Fibreoptic therapy

Your baby will be wrapped in a special blanket containing fibreoptics, which shines little lights directly on to their skin. You can still cuddle and feed your baby, so it is better for bonding. Fibreoptic treatment may be offered first if your baby is premature (NHS 2015).

Although light is an effective treatment for jaundiced babies, don't try to treat your baby yourself by exposing them to sunlight (NICE 2010a). Sunlight can damage your baby's fragile skin (Harrison et al 2013) and make them too hot. Light treatment offered in hospitals is very safe and effective (Wong and Bhutani 2017).

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Exchange transfusion

If your baby has extremely high levels of bilirubin in their blood, perhaps caused by an underlying health problem, they may need an exchange transfusion (NHS 2015, NICE 2010a). This involves some of your baby’s blood gradually being replaced with suitable blood from a donor.

Your baby will have close care to make sure they stay well during the treatment, which may take several hours. The new blood won't contain any bilirubin, so the bilirubin levels in your baby's blood will fall (NHS 2015).

If your baby does need to spend some time in hospital, find out how to care for them in the neonatal unit.
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BabyCentre's editorial team is committed to providing the most helpful and trustworthy pregnancy and parenting information in the world. When creating and updating content, we rely on credible sources: respected health organisations, professional groups of doctors and other experts, and published studies in peer-reviewed journals. We believe you should always know the source of the information you're seeing. Learn more about our editorial and medical review policies.

Cleveland L, Hill CM, Pulse WS, et al. 2017. Systematic review of skin-to-skin care for full-term healthy newborns. J Obstet Gynecol Neonatal Nurs 46(6):857-69.

Eghbalian F, Rafienezhad H, Famal J. 2017. The lowering of bilirubin levels in patients with neonatal jaundice using massage therapy: A randomized, double-blind clinical trial. Infant Behav Dev 49:31-36

Harrison S, Nowak M, Devine S, et al. 2013. An Intervention to Discourage Australian Mothers from Unnecessarily Exposing Their Babies to the Sun for Therapeutic Reasons. J Tropical Pediat 59(5):403-6. academic.oup.comOpens a new window [Accessed August 2018]

Horta BL, Victora CG. 2013. Long-term effects of breastfeeding: a systematic review. World Health Organization. www.who.intOpens a new window

LLL GB. nd. Jaundice in health newborns. La Leche League GB. Breastfeeding information. www.laleche.org.ukOpens a new window [Accessed August 2018]

McDonald, Middleton P, Dowswell T, et al. 2013. Effect of timing of umbilical cord clamping of term infants on maternal and neonatal outcomes. Cochrane Database of Systematic Reviews (7): CD004074. onlinelibrary.wiley.comOpens a new window [Accessed August 2018]

NHS. 2015. Newborn jaundice. NHS Choices, Health A-Z. www.nhs.ukOpens a new window [Accessed August 2018]

NHS Inform. 2018. Newborn essentials. NHS Inform, Healthy living, Pregnancy and baby. www.nhsinform.scotOpens a new window [Accessed August 2018]

NICE. 2010a. Jaundice in newborn babies: information for the public. National Institute for Health and Care Excellence. www.nice.org.ukOpens a new window [Accessed August 2018]

NICE. 2010b. Jaundice in newborn babies under 28 days. Last updated May 2016. National Institute for Health and Care Excellence, Clinical guideline, 98. www.nice.org.ukOpens a new window [Accessed August 2018]

NICE. 2015. Jaundice in the newborn.. National Institute for Health and Care Excellence, Clinical knowledge summaries. cks.nice.org.ukOpens a new window [Accessed August 2018]

Rull G. 2014. Glucose-6-phosphate Dehydrogenase Deficiency. Patient.infoOpens a new window, Haematology. www. patient.infoOpens a new window [Accessed August 2018]

Wong RJ, Bhutani VK. 2017. Pathogenesis and etiology of uncomplicated hyperbilirubemia in the newborn. UpToDate

Chess Thomas

Chess Thomas is a freelance health writer and former research editor at BabyCentre.

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