What is jaundice?

Jaundice is a yellow discolouration of the skin or the white areas (sclera) of the eyes. It usually results from high bilirubin levels in the blood. Jaundice in newborns is common. Mild jaundice occurs in about 1 in every 2 full-term newborns and is more common in premature babies. You’re most likely to notice it from the third day after birth.

Jaundice is usually harmless and typically disappears in 1 to 2 weeks. But all cases of jaundice in newborn babies should be checked by a doctor or nurse.

What are the symptoms of jaundice?

Jaundice in a newborn will cause their skin and the whites of their eyes to go yellow. It typically starts on the face and head. If the level of bilirubin increases in your baby’s blood, the discolouration (yellowing) will spread down their body. Some babies might also be drowsy and have difficulty feeding.

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What causes jaundice?

Physiological jaundice

New red blood cells are being made and old red blood cells are being destroyed all the time — this is part of your body’s normal functioning. Bilirubin is a product of the destroyed red blood cells. Bilirubin is usually processed in the liver and then leaves the body via faeces (poo).

Newborn babies’ livers sometimes aren’t yet developed enough to process bilirubin effectively. This results in a bilirubin overload, which makes their skin turn yellow. By about 2 weeks of age, your baby's liver is more developed and better at removing bilirubin. This cause of jaundice is not a concern and resolves on its own.

Premature babies are more likely to develop jaundice that babies born on time.

Breast milk jaundice

Babies who breastfeed may have jaundice for a longer period of time, for reasons not fully understood.

This type of jaundice usually resolves without treatment, after several weeks. You do not need to stop breastfeeding.

Dehydration

Some babies develop jaundice because they are not feeding well enough. Usually this resolves by ensuring that the baby is getting enough breastmilk or formula.

Hypothyroidism

Low thyroid levels can also cause jaundice in newborn babies.

Blood group incompatibility

A rare type of jaundice occurs when yours and your baby's blood groups are not compatible (usually ABO or Rhesus factor incompatibility).

This isn't usually a problem if it’s your first pregnancy because your blood doesn’t mix with your baby's blood during pregnancy. But during the birth, some of the baby's blood might mix with your blood, causing you to develop antibodies against the baby’s blood group.

These antibodies may become active during a following pregnancy and cross the placenta to attack a second baby's red blood cells. The destruction of the red blood cells causes more bilirubin to be released into the baby's bloodstream, leading to jaundice. This type of jaundice is usually seen within the first 24 hours after birth.

Infection

Babies with an infection, such as a urinary tract infection, may also experience jaundice.

Biliary atresia

Biliary atresia is a rare cause of jaundice in babies. It happens when the tubes that carry bile from the liver to the intestine become scarred. Babies with this condition usually grow normally and look well at first, but they will become very ill with serious liver disease if they aren't diagnosed and treated early. Their jaundice will usually persist after 2 weeks of age, and they might also have pale-looking poo.

Progressive Familial Intrahepatic Cholestasis

Progressive Familial Intrahepatic Cholestasis (PFIC) is a rare cause of jaundice in babies. It occurs due to genetic issues affecting bile production in the liver. Their jaundice will usually persist or be noticed after 2 weeks of age, and they might also appear itchy. Babies with this condition may become very sick with serious liver disease if they aren't diagnosed and treated early. Diagnosis of PFIC involves genetic testing.

When should I see my doctor?

Jaundice is usually harmless, but a nurse or doctor should check and monitor every newborn baby with jaundice to rule out a serious cause.

You should take your baby to the doctor if:

• your baby is unwell, feeding poorly and not gaining enough weight
• your baby's poo becomes pale or their urine (wee) becomes dark
• your baby develops jaundice in the first 48 hours after birth
• the jaundice becomes more noticeable after a week
• the jaundice hasn't gone away after 2 weeks

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How is jaundice diagnosed?

Jaundice is a clinical diagnosis — this means that your doctor can usually tell that your baby has jaundice by examining them. Your baby may need tests to diagnose the cause of their jaundice, including:

• blood tests
• urine tests
• an ultrasound of the liver

How is jaundice treated?

Treatment for jaundice in newborns depends on the severity and cause.

If your baby has mild jaundice, it is treated by helping them stay well-hydrated with frequent breast or formula feeds.

Babies who develop jaundice several days after birth need careful monitoring. This involves heel prick blood tests to check and monitor the bilirubin levels in their blood.

If your baby’s bilirubin levels are high, they might need phototherapy (blue light) treatment.

Phototherapy is treatment with a special kind of blue light that helps your baby’s liver to breakdown the bilirubin more easily. This treatment is very easy, painless and safe.

Your baby may be treated with a special blanket that emits the phototherapy. In other cases, your baby may have treatment in a cot under blue lights, with their eyes covered for protection.

Phototherapy has minimal side effects, and most babies manage it well. Your baby might have a mild rash and/or runny poo for a few days. Some babies might need extra feeds during this time.

In some cases, phototherapy is only needed for 24 hours or less. In other cases, it may be required for a few days.

If your baby has breast milk jaundice, you do not need to stop breastfeeding. This type of jaundice is usually mild and should get better by itself with time. Talk to your child health nurse or doctor if you're worried about what to do.

How is severe jaundice treated?

Severe jaundice, where bilirubin levels are very high, might need treatment with an exchange blood transfusion. This is when a baby’s own blood is replaced with compatible fresh blood. This treatment is very uncommon.

Can jaundice be prevented?

Jaundice can’t be prevented, but can usually be treated easily when it occurs.

Complications of jaundice

Very high levels of bilirubin in the blood can cause brain damage and hearing loss. This occurs very rarely, since bilirubin levels are monitored closely while your baby is in hospital.

The best way to avoid complications of jaundice is to follow the instructions you get from your health team.

Resources and support

For more information about the causes and management of jaundice in newborns see the Sydney Children’s Hospital Network website.

For more information about biliary atresia see the Sydney Children’s Hospital Network website.

For more information about Progressive Familial Intrahepatic Cholestasis see the Liver Foundation website.