Version July 2025
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JAUNDICE OVERVIEW —
Jaundice is the medical term for a yellow-tinged coloring of the skin or mucous membranes (such as the thin inner lining of the eyes and mouth). The yellow color is caused by a natural pigment called bilirubin, which is a waste product that the body creates when it breaks down old red blood cells. It is normal for all babies to have an increase in their blood bilirubin levels during the first three to five days after birth. When bilirubin builds up in the skin and blood to levels that are higher than normal, babies develop jaundice.
Jaundice is not a disease, but rather a sign of an elevated blood bilirubin level. The medical term for this is "hyperbilirubinemia."
If not treated, high bilirubin levels can lead to serious problems, including brain damage. For this reason, all babies should be checked for jaundice soon after birth. Babies who have signs of severe jaundice, such as jaundice during the first 24 hours after birth or yellowing of the palms of the hands and soles of the feet, require urgent testing to evaluate for severe hyperbilirubinemia.
Fortunately, safe and effective treatments are available to prevent more serious conditions.
Approximately 80 percent of babies have visible jaundice, which usually resolves by seven days of age. Only 10 to 15 percent of babies develop bilirubin levels that require treatment. Only 2 percent of babies or less are at risk for developing severe hyperbilirubinemia.
JAUNDICE SYMPTOMS
Typical signs of jaundice — Jaundice is not painful. Initially, it causes the skin and mucous membranes (such as the gums and lining of the eyes) to become yellow. As it progresses, the palms of the hands and soles of the feet, as well as the whites of the eyes, may look yellow or show deeper shades of yellow coloring. These changes may be hard to see in babies with darker skin or if a baby is unable to open their eyes.
When jaundice is visible, it:
●Is often noticeable first on the face; then on the chest, stomach, and groin areas; then farther along the arms, legs, wrists, and ankles; and then finally on the palms, soles of the feet, and nailbeds. However, in some babies, this head-to-toe progression of jaundice may not be seen, and the jaundice may appear over the entire body like a tan.
●Can be checked by gently pressing your finger on your baby's forehead or nose (called "blanching" the skin). If the skin is jaundiced, it will appear yellow when the finger is removed (just before blood returns to the area).
●Can best be monitored by gently pressing over any area where the bone is close to the skin, such as the forehead, chin, center bone of the chest (sternum), hip bones, elbows, knees, wrists, or ankles. In some babies, this can help check to see if the jaundice is progressing.
●Should be checked periodically during the birth hospitalization (usually more than once before the baby goes home). Before you take your baby home from the hospital after birth, the staff should teach you how to recognize jaundice. If your baby has been discharged home sooner than three days (<72 hours) after birth, you should check your baby's skin color daily (in the daylight) until the next scheduled appointment and during the first week after birth.
Your baby should be taken to see a doctor or nurse for a checkup within one to three days after going home. Before discharge, the doctor will review the results of the bilirubin tests with you and determine when your baby needs follow-up to recheck jaundice. In some cases, a repeat bilirubin test may be needed at the follow-up visit.
Signs of worsening jaundice — Call your baby's doctor if your baby has jaundice and any of the following occurs:
●The yellow color is visible at the elbows and knees or lower (towards the hands and feet), is becoming a deeper shade of yellow in appearance (color changing from a lemon yellow to an orange-yellow or yellow-brown), or if the whites of the eyes or eyelids appear yellow.
●Your baby has a fever of 100.4°F (38°C) or higher.
●Your baby has any difficulty breastfeeding or sucking and swallowing.
●Your baby is more sleepy than usual.
●Your baby is hard to wake up or keep awake to eat.
●Your baby is irritable and is difficult to console.
●Your baby has a high-pitched or shrill-sounding cry.
●Your baby starts to arch their neck or body backwards.
●Your baby seems to be working harder than normal to breathe.
CAUSES OF JAUNDICE
Common causes — Jaundice is caused by the buildup of bilirubin in the blood, which can lead to its buildup in the body's tissues (such as skin). Bilirubin is a yellow pigment that the body produces when red blood cells are broken down. It is naturally removed by the liver and then excreted in stool and urine. Bilirubin levels become high when it is made faster than it can be removed.
One reason that bilirubin levels are higher in babies is that more red blood cells are broken down, which causes more bilirubin to be made. Newborn babies make two to three times more bilirubin than adults. This can be due to:
●Bruising and mild injuries during delivery (especially following difficult births, use of forceps, or vacuum assistance).
●When a pregnant person's and their baby's blood type is different (or "incompatible"); the person's immune system may cause more of the baby's red blood cells to break down. Therefore, it is important for pregnant people to know their blood group (A, B, AB, or O) and Rh factor status (negative or positive). People whose blood group is O or Rh factor is negative should talk with their doctor to see if their baby's blood type has also been checked.
●Inherited causes of red blood cell breakdown, such as deficiency of a red blood cell enzyme called glucose-6-phosphate dehydrogenase (G6PD). G6PD deficiency traits are more common in males and in people of African American, Asian, Latin American, Mediterranean, Middle Eastern, and Native American ancestries compared with those of Northern and Western European ancestries.
●Illness, such as infection.
Another reason that bilirubin levels are higher in babies is that not enough bilirubin is being eliminated in the urine and stools. This is because newborn babies' bodies eliminate bilirubin more slowly than adults, particularly for babies who are born before 38 weeks or have certain rare genetic conditions. Additionally, if a baby does not get enough breast milk in the days after birth, they can become dehydrated, which can then lead to severe hyperbilirubinemia as well as other problems.
Breastfeeding — Jaundice is normally seen in breastfed babies for two key reasons:
●First, some babies do not get enough breast milk because they have difficulty feeding or the mother is not producing enough breast milk. If this happens, the baby may lose a large amount of weight, which increases bilirubin levels. Increasing the mother's milk supply, breastfeeding frequently, and making sure that the baby has a good "latch" can help ensure that the baby gets enough milk. (See "Patient education: Common breastfeeding problems (Beyond the Basics)".)
●Second, "breast milk jaundice" can also occur in breastfed babies. This begins the first week after birth, continues to peak during the two weeks after birth, and declines slowly over the next few weeks. It is thought to be due to how a baby's immature liver and intestines process breast milk, which results in a slower removal of bilirubin from the body. It is not caused by a problem with the breast milk itself. Jaundice is not a reason to stop breastfeeding as long as a baby is feeding well, gaining weight, and otherwise growing. Breastfeeding has well-known and proven benefits for both mother and baby. (See "Patient education: Deciding to breastfeed (Beyond the Basics)".)
Babies with jaundice due to breastfeeding rarely need treatment aside from increasing breast milk intake as needed, unless there is a risk of developing severe hyperbilirubinemia. Before you leave the hospital after giving birth, your doctor will determine the risk of severe hyperbilirubinemia based on your baby's bilirubin levels. They will also discuss the timing for follow-up, need for repeat bilirubin tests, or the possibility of needing treatment with a special blue light called phototherapy. (See 'Evaluation of jaundice' below and 'Phototherapy' below.)
JAUNDICE COMPLICATIONS —
At low levels, bilirubin is not harmful. Complications only occur in babies whose blood bilirubin levels reach harmful levels.
If bilirubin levels become too high, this can affect the brain and cause neurological damage, called "acute bilirubin encephalopathy." This is reversible if treated immediately. If treatment is not timely, the damage can become irreversible or permanent. This is called "kernicterus" or "chronic bilirubin encephalopathy."
Serious outcomes are very rare if the baby is frequently monitored and treated urgently when needed. In some cases, babies at high risk for severe hyperbilirubinemia may be treated sooner to help prevent brain damage from rising and toxic levels of bilirubin. (See 'Jaundice treatment' below and 'Prevention of severe hyperbilirubinemia' below.)
EVALUATION OF JAUNDICE —
Newborn jaundice is identified by visually examining the baby after birth. Testing for bilirubin levels in the blood or the skin confirms the presence of hyperbilirubinemia.
The blood test involves collecting a small amount (less than one-quarter teaspoon) of blood from the baby. Results of blood testing are available in most hospitals within a few hours.
In some hospitals, screening for high bilirubin is at first performed by a device that measures bilirubin levels in the skin (referred to as "transcutaneous" screening). Although transcutaneous measurement may closely estimate levels of bilirubin in the blood, it has some limitations and is not as sensitive as a blood test. Therefore, when the skin measurement exceeds a normal value, blood testing is done to make sure that the level of bilirubin is accurate.
If a baby still has jaundice after one week of age, testing is also done to check bilirubin levels and rule out a serious condition (such as a liver condition that leads to delayed bilirubin removal).
JAUNDICE TREATMENT —
The goal of treating jaundice is to efficiently and safely reduce the level of bilirubin in the blood before it becomes toxic. Babies with mild hyperbilirubinemia may need no treatment at all other than increasing milk intake (see 'Breastfeeding' above). Babies with higher bilirubin levels benefit from frequent assessment, and some will need treatment (which is usually brief). This treatment is described below.
Jaundice is common in babies who are born before 38 weeks. Premature babies are more vulnerable to hyperbilirubinemia because brain toxicity occurs at lower levels of bilirubin than in term babies. As a result, premature babies are treated at lower levels of bilirubin but with the same treatments discussed below.
Frequent feeding — Providing adequate milk is an important part of preventing and treating jaundice because it helps in the removal of bilirubin in stools and urine. You will know that your baby is getting enough milk if your baby has at least five to six wet diapers per day, the color of their stools changes from dark green to "mustard" yellow, and your baby seems satisfied after feeding. If your baby is not getting enough milk through breastfeeding, your doctor can talk to you about options such as supplementing with expressed breast milk, donor breast milk, and in some cases, formula. (See "Patient education: Common breastfeeding problems (Beyond the Basics)", section on 'Management of inadequate intake'.)
Phototherapy — Phototherapy is the most common medical treatment for hyperbilirubinemia in babies. It is a special "blue light" therapy that does not contain ultraviolet light and is usually delivered by LED lights or specialized optical fibers. In most cases, phototherapy is the only treatment required.
The blue light breaks down bilirubin into compounds that are easier for a baby's body to eliminate in stool and urine. In almost all babies, treatment with phototherapy is successful in decreasing bilirubin levels within 24 to 48 hours.
Phototherapy is usually given in a hospital. In some cases, it can be done at home if the baby is healthy and at lower risk for developing severe hyperbilirubinemia.
For the treatment to be successful, babies should have as much skin as possible exposed to the light. Babies are usually naked except for a diaper and eye shields and placed in an open bassinet or warmer. Eyes are shielded by using patches or a special mask to protect the eyes from the glare of the light (figure 1). Phototherapy is usually continuous and can be briefly stopped for feeding and skin-to-skin care of the baby. Experts often recommend approximately 18 to 20 hours of light treatment during a 24-hour period. Some hospitals prescribe special phototherapy blankets that allow treatment to continue while you hold or feed your baby.
Exposure to sunlight was previously thought to be helpful for treating jaundice, but is no longer recommended due to the risk of sunburn and exposure to harmful ultraviolet rays. Sunburn does not occur with the lights used in phototherapy. Indirect sunlight may be an option if phototherapy is not available.
Phototherapy is stopped when bilirubin levels in the blood drop to a safe level. It is common for babies to still appear jaundiced for a period of time after phototherapy is completed. Bilirubin levels may rise again in 18 to 24 hours after stopping phototherapy. For some, this requires follow-up testing to decide the need for repeat treatment.
Side effects — Phototherapy is very safe, but it can cause temporary side effects such as skin rashes or looser stools. Overheating and dehydration can occur if a baby does not get enough milk. Under phototherapy, the baby may look "blue." It's important to regularly check the baby's skin color, temperature, and number of wet diapers to monitor for side effects.
Very rarely, some babies with underlying liver disease can develop a dark, grayish-brown discoloration of the skin and urine; this is sometimes called "bronze baby" syndrome. This is not harmful and gradually goes away without treatment after several weeks.
Breastfeeding during phototherapy — It is important for babies receiving phototherapy to drink adequate fluids (ideally breast milk) since bilirubin is eliminated in urine and stool. Breastfeeding should continue during phototherapy. Babies should not be given plain water. If a baby develops severe dehydration, they may need treatment with intravenous (IV) fluids.
Babies who are not able to drink enough breast milk lose more weight than expected during the first week. To avoid dehydration, some babies may need extra expressed (pumped) breast milk or medically recommended formula for a few feeds. Mothers who choose to supplement with formula should continue to breastfeed and/or pump regularly to maintain their milk supply.
There is some controversy about whether to supplement with special formula for exclusively breastfed babies. This decision should be made after discussion with your medical team, and it is a good idea to talk to your baby's doctor or nurse first if you are considering this. It is very rare to need to completely stop breastfeeding for medical reasons. (See "Patient education: Breastfeeding guide (Beyond the Basics)".)
Exchange transfusion — Babies whose bilirubin levels increase to toxic levels despite other treatments, or who have signs of or are at significant risk for brain damage, may need something called "emergency exchange transfusion." This is a life-saving procedure that is used to rapidly decrease dangerously high levels of bilirubin. In this treatment, donor adult blood is transfused to replace the baby's blood. This is usually done during a two to three hour procedure in an intensive care setting.
PREVENTION OF SEVERE HYPERBILIRUBINEMIA —
Preventing severe hyperbilirubinemia is important to avoid serious life-long complications. Babies who are at risk for hyperbilirubinemia need to have timely follow-up visits with their doctor; these must be scheduled at the time of hospital discharge.
The following information only applies to healthy babies who are born at term or late preterm (within a month of their due date; these babies do not typically require special care in the neonatal intensive care unit or "NICU").
Screening test — Experts recommend that all newborns, regardless of age, have their bilirubin levels tested before going home from the hospital. Babies who are jaundiced before one day of age should also have repeat testing.
In addition, all babies should be screened for factors that increase the risk for bilirubin-related brain injury. These include babies who are born before 38 weeks, blood group incompatibilities, G6PD enzyme deficiency, low albumin (protein) level, and illness (such as an infection). (See 'Common causes' above.)
Monitoring and prompt treatment — Parents, other caregivers, and healthcare teams should watch babies closely if jaundice develops. Timely identification and treatment are important to prevent serious complications of hyperbilirubinemia. You should contact your baby's doctor or nurse urgently if you are concerned about worsening jaundice or if your baby is not looking well or showing unusual behavior. Parents and healthcare teams should not delay treatment for any reason. (See 'Signs of worsening jaundice' above.)
WHERE TO GET MORE INFORMATION —
Your baby's health care provider is the best source of information for questions and concerns related to your baby's medical problem.
This article will be updated as needed on our website (www.wolterskluwer.com/en/solutions/uptodate/roles/patients-caregivers). Related topics for patients, as well as selected articles written for health care professionals, are also available. Some of the most relevant are listed below.
Patient level information — UpToDate offers two types of patient education materials.
The Basics — The Basics patient education pieces answer the four or five key questions a patient might have about a given condition. These articles are best for patients who want a general overview and who prefer short, easy-to-read materials.
Patient education: Jaundice in babies (The Basics)
Patient education: Gilbert syndrome (The Basics)
Patient education: Glucose-6-phosphate dehydrogenase deficiency (The Basics)
Patient education: What to expect in the NICU (The Basics)
Patient education: Screening for hearing loss in newborns (The Basics)
Patient education: Caring for your newborn (The Basics)
Beyond the Basics — Beyond the Basics patient education pieces are longer, more sophisticated, and more detailed. These articles are best for patients who want in-depth information and are comfortable with some medical jargon.
Patient education: Common breastfeeding problems (Beyond the Basics)
Patient education: Breastfeeding guide (Beyond the Basics)
Professional level information — Professional level articles are designed to keep doctors and other health professionals up-to-date on the latest medical findings. These articles are thorough, long, and complex, and they contain multiple references to the research on which they are based. Professional level articles are best for people who are comfortable with a lot of medical terminology and who want to read the same materials their doctors are reading.
Classification and causes of jaundice or asymptomatic hyperbilirubinemia
Unconjugated hyperbilirubinemia in neonates: Risk factors, clinical manifestations, and neurologic complications
Crigler-Najjar syndrome
Diagnostic approach to the adult with jaundice or asymptomatic hyperbilirubinemia
Unconjugated hyperbilirubinemia in term and late preterm newborns: Screening
Gilbert syndrome
Unconjugated hyperbilirubinemia in neonates: Etiology and pathogenesis
Alloimmune hemolytic disease of the newborn: Postnatal diagnosis and management
Unconjugated hyperbilirubinemia in term and late preterm newborns: Initial management
The following organizations also provide reliable health information.
●National Library of Medicine
(www.nlm.nih.gov/medlineplus/healthtopics.html)
●American Academy of Pediatrics
(www.healthychildren.org/English/ages-stages/baby/pages/Jaundice.aspx)
●Parents of Infants and Children with Kernicterus
●Academy of Breastfeeding Medicine
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