Jaundice (also called hyperbilirubinaemia) is the name given for the yellowing of the skin and whites of the eyes due to an accumulation of the brownish yellow pigment bilirubin. A certain level of jaundice is quite common and “normal” in newborn babies. This article summarises the causes and symptoms of jaundice. For more information see Jaundice in Breastfeeding Babies and Treatment for Jaundice.
Causes of jaundice in newborn babies
During pregnancy the developing baby needs extra red blood cells in order to absorb enough oxygen from the placenta. After birth these extra red blood cells are no longer needed. They are broken down releasing biliverdin (a green pigment) which is then changed into bilirubin (a brownish yellow pigment). The bilirubin is made water soluble (“conjugated bilirubin”) in the baby’s liver so that it can be excreted via the poops (stools). The yellow skin colour of jaundice appears when the baby’s immature liver struggles to process the temporary build up of bilirubin.
Bilirubin levels usually peak around the third to fifth day and then gradually fall and most newborn jaundice doesn’t need treatment1. After about two weeks of age, less bilirubin is produced and jaundice often disappears naturally at this point 2.
Higher levels of bilirubin
Levels will be higher if the baby is not feeding well and so not excreting the bilirubin via his dirty nappies or if he has other risk factors or certain medical conditions. Bilirubin can also be easily reabsorbed from the bowel in a newborn baby who is not feeding well (enterohepatic circulation). For a full discussion of the types of jaundice in breastfed babies and the risk factors for high levels of jaundice see Jaundice in Breastfeeding Babies.
Are there any benefits to jaundice?
Normal newborn jaundice may be beneficial as biliverdin is thought to have anti-inflammatory properties 3 and bilirubin may have anti-oxidant properties 4. There is also new and ongoing research suggesting jaundice could protect babies from sepsis (a bacterial infection)56.
Is jaundice dangerous?
If bilirubin levels continue to rise this can cause sleepiness and poor feeding which in turn worsens the jaundice. Too much bilirubin over a certain threshold acts as a toxin that can cause permanent brain injury. See Jaundice in Breastfeeding Babies for more information on types of jaundice and risk factors for high levels. In rare cases high levels can lead to acute bilirubin encephalopathy (ABE) or kernicterus. These names are often used interchangeably however the American Academy of Pediatrics makes a distinction between the two:
Acute bilirubin encephalopathy
In the early stages of acute bilirubin encephalopathy babies will be lethargic, floppy (hypotonic) and not suck very well. Without treatment this can progress to an increased sleepiness, being irritable and tense with back and neck arching when awake. The baby may have a fever and a high pitched or shrill cry 7.
Kernicterus is the more advanced chronic form of bilirubin encephalopathy which can lead to permanent damage to the baby’s central nervous system. In this phase the baby stops feeding and may be impossible to rouse leading to coma or seizures. If the baby survives, they will probably show handicaps such as a form of cerebral palsy, a problem with hearing, tooth enamel, and paralysis of upward gaze (AAP, 2004).
What are the symptoms of jaundice?
Yellowing of the skin
The yellow skin colour of jaundice starts at the head and moves down the body towards legs and feet as the levels rise and the condition worsens. Jaundice below the level of the tummy button or on the palms of hands and soles of feet should always be reported immediately to a doctor. Any yellowing of skin and whites of the eyes in your baby’s first 24 hours is a particular concern.
Pale coloured poop
Normal newborn baby poop goes through distinct colour changes in the first five days (black, dark green, khaki, brown and finally yellow) and usually remains mustard/yellow after day five. Poop that is pale or chalky white should always be reported to your health professional. You can download the Children’s Liver Disease Foundation’s leaflet Jaundice in the New Born Baby (pdf) for further information and a stool colour guide.
Jaundice may make a baby sleepy and unable to feed well, they may have a high pitched cry or seem limp and floppy.
Urine should be pale coloured or colourless, dark urine could be a symptom of jaundice.
Your health professional will check bilirubin levels by a blood test or transcutaneous bilirubinometry, see Treatment for Jaundice. Checking for jaundice by observing the progress of the yellow colour in your baby’s skin from head to toe is not as reliable as medical testing:
Jaundice is not usually visible to the eye until bilirubin levels reach at least 4mg/dL (68 µmol/L). As bilirubin levels rise, the yellow colour spreads from the head to the chest (about 10mg/dL [170 µmol/L] to the abdomen and finally (usually when levels reach more than 15mg/dL [255 µmol/L]) to the palms and soles of the feet (Walker, 2006). Although the color of the baby’s body can provide a general indication of the severity of jaundice, research has found that bilirubin levels cannot be reliably gauged by skin colour alone
A video from Global Health Media Project; Newborn Care Series: Jaundice, explains how to check for jaundice by applying finger tip pressure to the skin and then checking for a yellow colour when the pressure is released. This is done in natural daylight (see 2 minutes 04) and gives a summary of what to look out for (at 5 minutes 27 seconds). Remember that bilirubin levels cannot be accurately gauged by skin colour alone by a parent. Always be guided by your health professional.
Frequently asked questions
For more answers to frequently asked questions about jaundice see:
A certain level of jaundice is a natural phenomenon after birth due to a break down of excess red blood cells releasing the yellow pigment bilirubin. If the levels of bilirubin get too high however, this could be dangerous for your baby. Symptoms include a yellowing of the skin which progresses down the baby’s body from head to toe, sleepy behaviour and poor feeding, pale coloured poops and dark coloured urine. Seek medical attention if you have any concerns and if there is:
- Jaundice (yellowing of skin and whites of the eyes) in your baby’s first 24 hours
- Jaundice below the tummy button and on palms of hands and soles of feet
- Jaundice in conjunction with the danger signs of poor feeding, lethargy, convulsions
- Very pale or chalky white poop or stools that appear fatty
- Dark urine
For more information about the different types of jaundice, jaundice while breastfeeding and which babies are more at risk of jaundice see Jaundice in Breastfeeding Babies and for information about treatments that protect breastfeeding see Treatment for Jaundice.