Neonatal jaundice, or the appearance of yellow skin and eyes in an infant, is one of the most common newborn health conditions. About 60% of babies develop jaundice within 2-3 days after delivery.
Jaundice is caused by an accumulation of bilirubin in the body. When red blood cells break down naturally, this yellow substance is formed. Our livers usually process and remove bilirubin, but newborn livers are not functioning at full capacity right away and they can’t break down excess bilirubin as easily. The mother’s liver performed this process before the baby was born.
Instead of exiting through a newborn’s stool, excess bilirubin is reabsorbed into the body, building up in the blood and causing the skin and eyes to appear yellow. This is called physiologic jaundice – the type we see most often.
For many babies, it takes less than a week for the liver to excrete the excess bilirubin on its own without treatment. In rare cases, excess bilirubin can deposit in organs beyond the skin – including the brain, which can cause permanent brain damage.
Babies are at increased risk of developing jaundice if they are:
- Born prematurely
- Of East Asian descent
- A sibling of a child who had neonatal jaundice
We check every baby for jaundice before they leave the hospital and usually can tell just by the skin color. If we suspect high levels of bilirubin, we’ll confirm with a blood test and recommend follow-up appointments if symptoms don’t go away on their own.
Phototherapy is a common and effective treatment – we arrange special lights around your baby for 12-24 hours to add oxygen to bilirubin and help it dissolve faster. At UT Southwestern, we often can bring phototherapy equipment into your room so you can continue to bond with your baby. However, if bilirubin levels remain high, your baby might require advanced care in the nursery.
Several types of jaundice have different health risks and treatment options. Here are four of the most common types and how we treat them:
Related reading: 7 strange-but-normal things to expect with a newborn
1. Inadequate feeding jaundice
If your baby isn’t taking in enough breast milk or formula, they can’t create enough stool to excrete the extra bilirubin. Working with a lactation consultant to improve and increase breast feedings or supplementing with formula can help resolve this type of jaundice.
If the bilirubin level in your baby’s blood is at 15-20 mg or higher, we’ll recommend phototherapy. When the bilirubin decreases, we’ll ask you to monitor for jaundice symptoms at home for the next week and to come back in if they don’t go away.
Related reading: 5 tips for successful breastfeeding
2. Breast milk jaundice
We don’t fully understand what causes this type of jaundice; it’s persistent and lasts several days. However, we suspect it occurs when a substance within breast milk prevents the breakdown of bilirubin. And it’s likely genetic, as breast milk jaundice tends to run in families.
This does not mean the mother should stop breastfeeding; nothing is wrong with the breast milk. We just need to monitor symptoms for up to 12 weeks after birth. Depending on bilirubin levels, your baby might require phototherapy. We’ll ask you to regularly update us until the jaundice symptoms subside. If they intensify for multiple days, we’ll request you come in right away for treatment.
Related reading: 6 factors that won’t decrease your breast milk supply
3. Rh incompatibility
This type of jaundice occurs when the mother has Rh negative blood and the baby has Rh positive blood. The combination causes the mother’s blood to make antibodies that break down the baby’s red blood cells more rapidly, increasing bilirubin levels.
This process begins in utero and is one of several reasons we’ll check your blood type during prenatal visits. If you’re Rh negative, we’ll give you an Rh immunoglobulin (RhoGAM) injection at week 28 of pregnancy, during delivery, and anytime you experience bleeding during the pregnancy to prevent these antibodies from developing. The medication contains antibodies that block your immune system from fighting against the baby’s Rh positive blood cells.
If you do not get these injections, your baby is at high risk to be:
- Anemic (low red blood cells) and might require an intrauterine blood transfusion (injecting donor red blood cells into the fetus)
- Born prematurely
- Very sick and need advanced care in the Neonatal Intensive Care Unit (NICU)
Phototherapy can help lower the baby’s bilirubin levels. If the amount continues to rise, we might give your baby intravenous immunoglobulin (IVIG), antibodies that slow the breakdown of red blood cells. IVIG also reduces the need for more intense treatment, such as a blood exchange transfusion.
4. ABO incompatibility
If a mother has type O blood and her baby has type A or B, her immune system will likely make antibodies against her baby’s blood cells. Unlike Rh incompatibility, this usually occurs after delivery when antibodies leak across the placenta into the baby’s blood.
This type of jaundice tends to be more robust, and we’ll typically care for these babies in the nursery, where they’ll need earlier and longer phototherapy treatment. If we know you’re type O, we’ll check your baby’s blood type right away and test it for antibodies. If we find them and your baby has significant jaundice, we’ll start phototherapy quickly. It can take a while for the antibodies to break down, so your baby might need to be under the lights for several days.
Like Rh incompatibility, if phototherapy is not effective, your baby might require an IVIG injection or a blood transfusion. I was ABO incompatible with my mom when I was born and had an exchange transfusion as a baby. As I tell families whose babies need one, I turned out just fine, and the technology for this procedure has only improved over time.
Related reading: 4 pregnancy blood tests not all patients need
Treating jaundice at home
If immediate treatment for jaundice isn’t required, or when your baby starts improving after treatment in the hospital, we’ll ask you to monitor symptoms at home. Along with yellowish skin and eyes, symptoms can include extreme sleepiness and difficulty feeding and gaining weight.
Your doctor may recommend:
- Putting your baby in a warm room with a big, sunny window. Take off all the baby's clothes and let them sit in the sunlight, which can help break down bilirubin, for an hour or two. This method helps prevent UV damage that direct sunlight outside can cause.
- Feeding your baby frequently. The more they eat, the more bowel movements they’ll have and the more bilirubin they’ll excrete. However, this is not a reason to start supplementing with formula if you’re breastfeeding, and there’s no reason to ever give water to a newborn.
Jaundice typically develops from the head to the feet. The legs and hands are usually last. If you notice jaundice in these areas, we need to see your baby right away because the jaundice has likely spread through their body and bilirubin levels are high.
Any time you see new or lingering symptoms of jaundice, talk with your child’s pediatrician. Follow-up appointments can help your baby avoid serious complications. While treatment isn’t always necessary, we won’t know unless we measure and monitor your baby’s bilirubin level.
The more we can head off complications, the healthier your baby will be – and the more time you can spend together at home instead of at the hospital.