Neonatal Jaundice

Neonatal jaundice is yellowing of a newborn’s skin and eyes due to a build-up of bilirubin in the blood. It is very common and often harmless, but when severe or occurring very early, it can be dangerous if not identified and treated promptly.

• Yellowing of the skin and the whites of the eyes, typically starting on the face and spreading downward as it becomes more severe
• Usually appears from day 2–3 of life in common, harmless (physiological) jaundice and fades within about two weeks
• Jaundice appearing within the first 24 hours of life, or that is severe, deep, or extends to the palms and soles, is more concerning and needs urgent assessment
• Poor feeding, excessive sleepiness, or high-pitched crying can indicate dangerously high bilirubin levels affecting the baby's brain

• Common, mild (physiological) jaundice results from the normal breakdown of extra red blood cells combined with a newborn's still-immature liver processing of bilirubin.
• More significant or early jaundice can result from blood group incompatibility between mother and baby, infection, prematurity, or other underlying conditions.

• Assessed by examining the extent of yellowing on the skin, along with the baby's age in hours or days, feeding, and activity level.
• A blood bilirubin level is measured to confirm the severity, particularly for early, rapidly worsening, or visually severe jaundice, and to guide treatment decisions.
• Assessment for an underlying cause (such as blood group incompatibility or infection) is carried out for early or severe jaundice.

Mild jaundice appearing after 24 hours of age in an otherwise well, feeding baby is often managed with continued frequent breastfeeding and close monitoring, as it typically resolves on its own.

Jaundice with a bilirubin level above the treatment threshold for the baby's age is treated with phototherapy (special blue light treatment), which helps break down bilirubin so it can be cleared from the body.

Very high or rapidly rising bilirubin levels, or jaundice appearing within the first 24 hours of life, require urgent hospital-level assessment and treatment, as this can indicate a more serious underlying cause and carries a risk of bilirubin-related brain injury if untreated.

In rare, severe cases where bilirubin remains dangerously high despite phototherapy, an exchange blood transfusion may be needed at a specialist facility.

• Encourage frequent breastfeeding from birth, as this helps the baby clear bilirubin more effectively.
• Ensure newborns are checked for jaundice in natural light in the days after birth, particularly before hospital discharge.
• Seek prompt medical assessment for jaundice appearing in the first 24 hours of life, or for a baby who is feeding poorly or unusually sleepy.
• Attend any recommended follow-up visit in the days after birth for a repeat check on jaundice and feeding.