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Newborn jaundice

Newborn jaundice is when your baby’s skin and the white parts of his eyes look yellow. It’s caused by the build-up of a substance in the blood called bilirubin. Newborn jaundice is very common—about 3 in 5 babies (60 percent) have jaundice.

Jaundice usually happens a few days after birth. Most of the time, it’s mild, doesn’t hurt your baby and goes away without treatment. But if a baby has severe jaundice and doesn’t get quick treatment, it can lead to brain damage.

What causes jaundice in newborns?

Your baby’s body recycles some red blood cells each day. Bilirubin is a yellow substance that forms as red blood cells break down. During pregnancy, your liver removes bilirubin for your baby. After birth, your baby’s liver may not be developed enough to properly remove bilirubin on its own. It can take a few days for your baby’s liver to be able to do this.

When a baby’s liver causes jaundice in the first days of life, it’s called physiologic jaundice. This is the most common kind of jaundice in newborns. But sometimes a health condition in your baby can cause jaundice. Babies with these health conditions are more likely to need treatment to help lower their bilirubin levels than babies with physiologic jaundice. These conditions include:

  • Blood type mismatches, like Rh disease. A small number of babies have different blood types than their mothers. These mismatches can lead to a faster breakdown of red blood cells.
  • Internal bleeding. This is bleeding inside the body. 
  • A problem with your baby’s liver. Your baby’s liver may not work well if he has an infection, like hepatitis, or a disease, like cystic fibrosis, that affects the liver. 
  • A problem with your baby’s red blood cells. Some babies have too many red blood cells. This is more common in some twins and babies who are small for gestational age. This means a baby who is smaller than normal based on the number of weeks he’s been in the womb. 
  • A genetic condition, like G6PD deficiency. This condition is when your body doesn’t have enough G6PD, an enzyme that helps your red blood cells work the right way. 
  • An infection, like sepsis. This is an infection in your baby’s blood. 
  • Bruising at birth. A bruise happens when blood leaks out of a blood vessel. Sometimes babies get bruises during labor and birth. When large bruises heal, bilirubin levels may rise.

Some babies are more likely than others to have jaundice. These include:

  • Premature babies. A premature baby is one who is born too early, before 37 weeks of pregnancy. A premature baby is more likely than others to have jaundice because his liver may not be fully developed.
  • Breastfed babies, especially babies who aren’t breastfeeding well. If you’re breastfeeding, feed your baby when he’s hungry. For most newborns, this is once every 2 to 3 hours (about eight to 12 times each day). Feeding this often helps keep your baby’s bilirubin level down. If you’re having trouble breastfeeding, ask your baby’s provider, a nurse or a lactation consultant for help. A lactation consultant is a person with special training in helping women breastfeed. 
  • Babies with East Asian or Mediterranean ethnic backgrounds. Ethnic background means the part of the world or the ethnic group your ancestors come from. An ethnic group is a group of people, often from the same country, who share language or culture. Ancestors are family members who lived long ago, even before your grandparents.

How do you know if your baby has jaundice?

When a baby has jaundice, a yellowish color usually first appears on his face. It then may spread to his chest, belly, arms, legs and white parts of his eyes. The best way to see jaundice is in good light, like in daylight or under fluorescent lights. Jaundice can be harder to see in babies with darker skin.

Call your baby’s health care provider right away if your baby:

  • Looks very yellow, orange or greenish-yellow
  • Is hard to wake up or won’t sleep at all
  • Has trouble breastfeeding or sucking from a bottle
  • Is very fussy
  • Has too few wet or dirty diapers

Call 911 or take your baby to the hospital if he:

  • Won’t stop crying or has a high-pitched cry
  • Arches backward
  • Has a stiff, limp or floppy body
  • Has strange eye movements

These may be warning signs of dangerously high levels of bilirubin that need quick treatment to prevent kernicterus. This is a kind of brain damage caused by high bilirubin levels. Kernicterus isn’t common because babies usually are treated before jaundice becomes severe. If untreated, kernicterus can cause:

How are babies checked for jaundice?

The American Academy of Pediatrics (AAP) recommends that all babies be checked for jaundice after birth while in the hospital. Your baby’s provider checks her with one or more of these tests:

  • Blood test. This is the best way to measure bilirubin levels. Your baby’s provider takes a small sample of blood from her heel to do this test.
  • Physical exam. Your baby’s provider checks your baby’s body for signs of jaundice. 
  • Skin test. Your baby’s provider places a device on your baby’s forehead to check her bilirubin level. The device measures the reflection of a special light that shines through her skin.

The AAP recommends that babies be checked for jaundice again at 3 to 5 days of age. This is the time when bilirubin levels are the highest. If your baby leaves the hospital before 72 hours (3 days) of age, she should be checked within the next 2 days.

How is jaundice treated?

Most babies with jaundice don’t need treatment. If your baby has mild jaundice, her provider may recommend that you breastfeed your baby more often so that she has more bowel movements. This helps to get rid of bilirubin.

Jaundice usually clears up within 2 weeks in formula-fed babies. It may last for more than 2 to 3 weeks in breastfed babies. If your baby’s jaundice lasts more than 3 weeks, talk to his health care provider.

If your baby has more severe jaundice, she may need treatment including:

  • Phototherapy treatment (also called light therapy or bili lights). This is when your baby is placed under special lights that help her body change bilirubin into a form that she can get rid of in her urine. While she is under the lights, your baby wears just a diaper and shields over her eyes. Some babies can lie on a light therapy blanket (also called a fiber optic blanket) that has tiny bright lights in it. You may use the blanket in place of, or along with, the overhead lights. Phototherapy can be done in the hospital or at home, and it’s safe for your baby.
  • Exchange transfusion. If phototherapy doesn’t work and your baby’s bilirubin levels are still very high, she may need a special type of blood transfusion called an exchange transfusion. An exchange transfusion gets rid of bilirubin by replacing your baby’s blood with fresh blood in small amounts.
  • Intravenous immunoglobulin (also called IVIg). If you and your baby have different blood types, your baby may get immunoglobulin (a blood protein) through a needle into a vein. This can help her treat her jaundice so that she’s less likely to need an exchange transfusion.

Last reviewed April 2013

See also: Premature babies

Call your doctor now if your baby...

  • Has a temperature above 100.4 F
  • Has trouble breathing or is hard to waken
  • Has blood in her vomit or stool
  • Has yellowish skin or eyes
  • Is having a seizure

Frequently Asked Questions

Is there any way to prevent RSV?

The season for respiratory syncytial virus (RSV) infection in the United States is usually October to April. It's wise to take precautions to help prevent it. The main thing to do is wash your hands often and thoroughly with soap and water. Make sure everyone who touches your baby has clean hands. Keep your baby away from crowds of people. Do not allow anyone to smoke around your baby. Cover your mouth when you cough or sneeze and don't share cups, spoons and forks with others. RSV is very contagious. Almost all babies get it before the age of 2. Talk to your baby's health care provider about ways to prevent RSV.

What is diphtheria?

Diphtheria is a disease caused by a bacteria. The disease causes a thick coating in the nose, throat and airway. It can lead to breathing problems, heart failure, paralysis or even death.

Diphtheria can be spread by coughing and sneezing. Symptoms may include a slow onset of a sore throat and low-grade fever.

The DTaP (for children) and Tdap (for adults) vaccines can protect against diphtheria, tetanus and pertussis. Your baby gets the DTaP vaccine in four doses: at 2 months, 4 months, 6 months and between 15 and 18 months.

If you’re thinking about getting pregnant, make sure you’re protected against diphtheria. If you need to get vaccinated, get the adult vaccine before pregnancy.

What is Haemophilus influenzae type b?

Hib is a serious disease caused by bacteria. It usually affects young children.

Hib is spread from person to person through coughing or sneezing. Hib can cause meningitis, pneumonia and other serious health problems.

The Hib vaccine protects against this disease. Your baby gets the Hib vaccine in three to four doses: at 2 months, 4 months, 6 months (some brands of the vaccine require a shot at 6 months, but others don’t) and between 12 and 15 months.

What is hepatitis B?

Hepatitis B is caused by the hepatitis B virus. It can lead to serious liver disease. Signs of hepatitis B infection include belly pain, joint pain, dark urine, loss of appetite, nausea, fatigue and jaundice. However, most people who have hepatitis B infection never show any signs.

You can catch hepatitis B if you’re in contact with bodily fluids of someone who has it. For example, you can get the virus from kissing or having sex with an infected person. You also can get it if you share needles with someone who has the virus. During pregnancy, a mom with hepatitis B can pass the infection on to her baby during childbirth. Pregnant women are tested for hepatitis B at a prenatal care visit.

Most people with hepatitis B get better and may not need treatment. However, if you have chronic (long-lasting) hepatitis B infection, you may need treatment with medicines called antivirals that fight the virus. If the liver is badly damaged, you may need a liver transplant. Babies and children are much more likely than adults to get chronic hepatitis B infection.

The hepatitis B vaccine can prevent infection in babies and adults. Your baby gets three doses of hepatitis B vaccine: at birth, 2 months and between 6 and 18 months.

What is measles?

Measles is a disease that is easily spread and causes rash, cough and fever. In some cases, it can lead to diarrhea, ear infection, pneumonia, brain damage or even death. Measles can cause serious health problems in young children. It also can be especially harmful to pregnant women and can cause miscarriage.

The measles, mumps and rubella (MMR) vaccine protects against these three diseases. Your baby gets the MMR vaccine in two doses: the first between 12 and 15 months, the second between 4 and 6 years.

If you’re thinking about getting pregnant, make sure you’re protected against measles. If you need to get vaccinated, get the MMR vaccine before pregnancy. Wait at least 1 month before trying to get pregnant after getting the shot.

What is meningitis?

Meningitis is an infection that causes swelling in the brain and spinal cord. It’s usually caused by a virus or bacteria. The infection can spread from person to person through coughing, sneezing, kissing or sharing drinks.

Most people get meningitis from a virus. If you get this kind of meningitis, you’ll probably get better in a few days without treatment. But the meningitis caused by bacteria can lead to brain damage and even death.

Adults may have symptoms like headache, fever and a stiff neck. These symptoms are sometimes mistaken for the flu. Babies may show different symptoms, like high fever, constant crying or even seizures.

If you think anyone if your family has meningitis, see your health care provider right away.

The Hib vaccine can protect against bacteria that cause meningitis. Your baby gets the Hib vaccine in three to four doses: at 2 months, 4 months, 6 months and between 12 and 15 months. Some brands of the vaccine require a shot at 6 months, but others don’t. Ask your provider if you have questions about when your baby gets the vaccine.

What is mumps?

Mumps is a disease that spreads easily from person to person, usually through coughing or sneezing.

It causes fever, headache and swollen glands around the jaw. It can lead to hearing loss, meningitis and painful, swollen testicles in men.

The measles, mumps and rubella (MMR) vaccine prevents against these diseases. Your baby gets the MMR vaccine in two doses: the first between 12 and 15 months, the second between 4 and 6 years.

If you’re thinking about getting pregnant, make sure you’re protected against mumps. If you need to get vaccinated, get the MMR vaccine before pregnancy. Wait 1 month before trying to get pregnant after getting the shot.

What is pertussis?

Pertussis (whooping cough) is a disease caused by bacteria. Pertussis leads to coughing and choking that can last for several weeks. Babies who catch pertussis can get very sick, and some may die. Most deaths from pertussis happen in babies less than 4 months old.

The number of pertussis cases in this country has more than doubled since 2000. This may be because protection from the childhood vaccine fades over time. In the last few years, there have been several large pertussis outbreaks. Outbreaks are common in places like schools and hospitals. The disease spreads easily from person to person, usually by coughing or sneezing. Most infants who get pertussis catch it from someone in their family, often a parent.

The DTaP vaccine for children and the Tdap vaccine for adults can protect you and your children from pertussis, diphtheria and tetanus. Your baby gets the DTaP vaccine in four doses: at 2 months, 4 months, 6 months and between 15 and 18 months. The pertussis part of the vaccine may weaken as your child gets older. So for the best protection, she gets a fifth shot before she starts school, around 4 to 6 years old.

All new parents need the pertussis vaccine. Until your baby gets her first pertussis shot at 2 months, the best way to protect her is for you to get the adult vaccine before pregnancy or soon after you have your baby. The vaccine prevents you from getting pertussis and passing it along to your baby. Caregivers, close friends and relatives who spend time with your baby should get vaccinated, too.

What is pneumonia?

Pneumonia is an infection in the lungs caused by bacteria or viruses.

Pneumonia can cause coughing, shortness of breath and chest pain. You can catch it from another person, even if he doesn’t look or feel sick.

Several vaccines can protect you from pneumonia by preventing infection from certain bacteria or viruses. One vaccine that protects against pneumonia is pneumococcal conjugate vaccine (PCV). Your baby gets the PCV vaccine in four doses: at 2 months, 4 months, 6 months and between 12 and 15 months.

Other vaccines that help protect against pneumonia include:

  • (Hib)
  • Influenza (flu)
  • , mumps, rubella (MMR)
  • , and (DTaP for children and Tdap for adults)
  • Varicella (chickenpox)

If you’re thinking about getting pregnant and are at risk for pneumonia, your provider may recommend that you get vaccinated before pregnancy. Talk to your provider if you think you may be at risk for pneumonia.

What is tetanus?

Tetanus (also called lockjaw) is a disease caused by bacteria that attacks the nervous system (that includes the brain, spinal cord and nerves).

Stiffness in the neck or stomach muscles may be early symptoms of tetanus. Tetanus also can cause the jaw to “lock,” so that a person can’t open his mouth or swallow. It also can cause serious, painful spasms of all muscles. It sometimes causes death.

Tetanus is not passed from one person to another. Instead, the bacteria that causes tetanus can enter your body through a break in your skin and cause infection. For example, if you step on a nail, cut your skin in an accident, or get a splinter, you may be at risk of tetanus infection.

The DTaP (for children) and Tdap (for adults) vaccines can protect you from tetanus, diphtheria and pertussis. Your baby gets the DTaP vaccine in four doses: at 2 months, 4 months, 6 months and between 15 and 18 months.

If you’re thinking about getting pregnant, make sure you’re protected against tetanus. If you need to get vaccinated, get the adult vaccine before pregnancy.

What’s an umbilical hernia?

This common hernia in infants usually appears as a soft lump or bulge beneath the belly button. You may see it most clearly when your baby is crying, pushing her belly outward. It happens when a portion of the intestine bulges through the abdominal wall. This happens when the muscles in the area fail to close around the belly button after the umbilical cord falls off. It's more common in girls, particularly African Americans, or premature babies.

Umbilical hernias usually aren't serious or painful to the baby and they go away without treatment by the fifth birthday - often much sooner. If you suspect your baby has a hernia, call your child's health care provider. It’ll be important to watch it for changes over time. If it enlarges or swells, or if you baby has severe pain, vomiting or weakness, call your child's health provider right away, as a serious complication could exist. If surgery is required, it’s usually a quick fix.

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