Jaundice in preterm and full-term babies

November 3, 2021

Have you ever seen a baby in a NICU or hospital nursery wearing only a diaper, lying under bright lights? The baby is receiving light therapy due to a condition called jaundice.

When a baby has jaundice, their skin or the white parts of their eyes can look yellow. It can also spread to the chest, belly, arms or legs. Often, healthy babies have some jaundice soon after birth, but it can be a sign that your baby’s liver isn’t working properly or isn’t fully developed. It can happen to babies born preterm or full term.

What exactly is jaundice?

Jaundice is the buildup of bilirubin in the blood. Bilirubin is a yellowish substance that is formed when red blood cells break down – a natural process in our bodies. It is the liver’s job to break down the bilirubin so it can be excreted from the body. It’s normal for a baby’s bilirubin level to be a bit high they are born. But if the liver is not working properly, it will not be able to remove the bilirubin, which then causes jaundice.

Is it jaundice common?

Newborn babies often get jaundice – in fact, about 50 percent of full-term babies get it. It can take a few days for a baby’s liver to become fully functional and do its job of getting rid of bilirubin. Usually, it is mild and goes away with treatment.

About 80 percent of preterm babies develop jaundice within a few days of birth. Babies born preterm- before 37 weeks of pregnancy-are more likely than full-term babies to develop jaundice because their livers aren’t fully developed or functional yet. It can take a week or more for a preterm baby’s liver to become fully functional. With treatment, most babies are fine. In rare cases, very high bilirubin levels can cause brain damage, so this is why treatment is usually started early.

A more severe form of jaundice can be caused by other factors, such as Rh disease, liver problems, an infection or a genetic condition.

Treatments for jaundice

Feeding your baby breast milk helps remove bilirubin in their stools and urine. If you’re breastfeeding, feed your baby when they’re 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 person with special training in breastfeeding (lactation consultant) for help.

Phototherapy is another treatment. During phototherapy, bright blue lights called bili lights are placed over your baby’s incubator to help reduce the amount of bilirubin in your baby’s blood. While under the lights, your baby’s eyes are protected with eye shields, and they may be turned frequently.  Your baby may be able to receive phototherapy at home using a special blanket or lights.

If your baby doesn’t respond to the bili lights, they may need additional treatment, such as intravenous immunoglobulin (IVIg), where your baby gets immunoglobulin (a blood protein) placed directly into their vein. If other treatments don’t work, your baby may need a blood exchange, which replaces your baby’s blood with donated blood to quickly lower bilirubin levels.

Know what to look for

Jaundice can occur even after your baby is home from the hospital. 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. You can check for jaundice by pressing one finger on your baby’s forehead or nose. If the skin is jaundiced, it will appear yellow when you take your finger away.

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

  • Looks yellow, orange or greenish-yellow, especially below the knees
  • 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
  • Has a fever
  • Arches their neck or body backwards
  • Is vomiting frequently

Go straight to the hospital or call 911 if your baby shows signs of jaundice and:

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

Bottom line

The good news is that jaundice is usually nothing to worry about. So try to relax as your baby takes a bath under the lights, knowing this is temporary. See our article for more detailed info.