Roughly six in ten term babies and eight in ten preterm babies develop visible jaundice in the first week. For most it is a normal adjustment that resolves without treatment. For a small number it is a sign of something that needs acting on promptly.
The timing of when the yellowing appears is the single most useful clue.
Why Newborns Turn Yellow
Bilirubin is produced when red blood cells break down. Newborns have a high red cell count at birth, and those cells have a shorter lifespan, so a great deal of bilirubin is produced in the first days.
At the same time, the newborn liver is still maturing and processes bilirubin slowly. The result is a temporary excess that colours the skin and eyes yellow.
This physiological jaundice typically appears after the first twenty four hours, peaks around day three to five, and fades over one to two weeks. It is a normal transition.
Timing Tells You Most of What You Need to Know
When the jaundice appears is more informative than how yellow the baby looks.
- Within the first 24 hours: never normal. This requires urgent assessment, and usually indicates blood group incompatibility or haemolysis
- Day 2 to 5: the usual pattern of physiological jaundice
- After day 7: needs evaluation, and may indicate infection or breast milk jaundice
- Persisting beyond 2 weeks in a term baby: requires investigation, particularly to exclude liver problems
Jaundice appearing on the first day is the one every parent should know about. It is not something to watch for a day.
How Doctors Assess It
Assessment combines how the baby looks with a measurement, because visual estimation is unreliable, particularly in darker skinned babies.
- Transcutaneous bilirubin: a painless meter pressed against the skin, used for screening
- Serum bilirubin: a blood test, which is definitive
- Blood group of mother and baby, and a Coombs test if incompatibility is suspected
- Haemoglobin and reticulocyte count to assess for haemolysis
- G6PD testing, since deficiency is common in parts of India and causes severe jaundice
The bilirubin level is plotted against the baby's age in hours, not days, and against gestational age. This is why a level acceptable at seventy two hours may require treatment at twenty four hours.
Risk Factors for Significant Jaundice
Some babies need closer watching from the outset.
- Prematurity, even late preterm at thirty five to thirty seven weeks
- Mother blood group O or Rh negative, with a differing baby group
- Bruising or a cephalhaematoma from delivery
- A previous sibling who required phototherapy
- G6PD deficiency, which runs in families
- Poor feeding and weight loss over seven percent
- Infection
- East Asian ethnicity
Babies discharged before seventy two hours should be reviewed within a day or two, because bilirubin often peaks after they have gone home.
Phototherapy: What It Involves
Phototherapy uses blue light of a specific wavelength that converts bilirubin in the skin into a form the body can excrete without needing the liver to process it.
The baby lies under the lights wearing only a nappy, with eyes covered for protection. Feeding continues, and the baby is taken out for feeds. Treatment usually lasts one to two days.
It is safe and well established. Side effects are loose stools, mild dehydration and temporary rash. Parents often find the eye patches distressing, though the baby is not.
Phototherapy is provided in our newborn unit with rooming in where the baby's condition allows.
When More Than Phototherapy Is Needed
Very high bilirubin levels can cross into the brain and cause kernicterus, a rare but permanent form of brain injury. Modern management is designed entirely around preventing this.
Where levels approach the danger threshold, exchange transfusion replaces the baby's blood with donor blood, rapidly removing bilirubin. Intravenous immunoglobulin is used in some cases of blood group incompatibility to reduce the need for exchange.
These are uncommon with timely detection, which is the entire argument for early review after discharge. Our neonatology department and NICU manage these situations.
Feeding Matters More Than Sunlight
Bilirubin is excreted in stool, so a baby who feeds well and passes stool frequently clears it faster. Poor feeding leads to dehydration, fewer stools, and rising bilirubin.
Feed at least eight to twelve times in twenty four hours, waking the baby if needed. Do not give water or glucose water. It does not help clear bilirubin and displaces milk, worsening the problem.
Placing a baby in sunlight is traditional advice that is not recommended. Sunlight through glass is ineffective, and direct sun risks burning and overheating a newborn. It also delays proper assessment.
When to Bring Your Baby Back
Return promptly if you notice any of these at home.
- Yellowing appearing in the first twenty four hours
- Yellowing spreading down to the abdomen, legs or feet
- The baby becoming difficult to wake, or feeding poorly
- A high pitched cry, arching of the back, or unusual stiffness
- Fewer than six wet nappies a day after day four
- Pale, chalky stools or dark urine, which suggest a liver problem
- Jaundice still present at two weeks
Pale stools with prolonged jaundice are particularly important, since biliary atresia requires surgery within the first weeks to have the best outcome.
Most newborn jaundice resolves on its own with good feeding. The situations that matter are jaundice on the first day, jaundice spreading to the legs, a sleepy baby who is not feeding, and jaundice persisting past two weeks. Any of those deserves same day review.
Our neonatology team at T. Nagar provides newborn assessment, bilirubin testing and phototherapy.
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