Newborn Jaundice: When Should You Worry?

By the third day, her face has taken on a golden tinge, and so have the whites of her eyes. Newborn jaundice, which doctors call icterus, is one of the most common events of the first days. In the vast majority of cases it is normal and goes away on its own.

It still needs watching, because jaundice that is too strong, or that hides another illness, can be serious. Here is how to spot it, what is normal, and the few signs that mean you should see a doctor without delay.

Why do so many newborns turn yellow?

The yellow colour comes from bilirubin, a substance produced when red blood cells break down. A newborn makes a lot of it, and the liver, still immature, struggles to get rid of it: it builds up in the skin. The liver matures within a few weeks, and the jaundice goes.

It is very common, although the figures vary: Naître et grandir estimates about 60% of newborns, while mpedia, the French pediatricians’ site, says one in three. This so-called physiological jaundice usually appears 24 to 48 hours after birth, is most visible around day 3, and disappears within one to two weeks in a full-term baby. In a premature baby it can last several weeks.

Some babies are more at risk, according to the Canadian Paediatric Society: those born before 38 weeks or weighing less than 2.5 kg, those whose blood group is incompatible with their mother’s, those with bruises or a swelling on the head after delivery, or whose older sibling needed a transfusion for jaundice.

How do you spot jaundice at home?

It starts on the face, then spreads to the chest. When it reaches the arms and legs, the Canadian Paediatric Society sees a sign that needs checking. To see it properly, according to the NHS and Naître et grandir:

• place your baby near a window, in daylight, without putting them in the sun;
• gently press the tip of the nose or the forehead: if the skin turns white, there is no jaundice; if it stays yellow or orange, there is;
• look at the whites of the eyes, and inside the mouth, under the tongue and in the cheeks;
• on olive or darker skin, rely mostly on the whites of the eyes.

Watch the nappy too. The first stools, meconium, are black or very dark green, then they turn yellow. Dark yellow or brown urine, or pale stools in cream, white, beige or grey, are a warning sign.

Normal jaundice or jaundice to watch: the table

These guides come from the NHS, the Canadian Paediatric Society and Naître et grandir.

Jaundice and breastfeeding: should you stop?

No. On the contrary, frequent feeds help: they make your baby pass stools, and bilirubin with them, explains the Canadian Paediatric Society. The NHS advises feeding your baby 8 to 12 times a day, waking a baby who is too sleepy for feeds; Naître et grandir gives the same guide from birth. If latching is difficult, ask for help without delay: a baby who drinks little becomes dehydrated, which can make the jaundice worse. Our article on getting breastfeeding off to a good start details the signs that your baby is drinking enough.

There is also jaundice linked to breast milk. According to Naître et grandir, it affects about 15% of breastfed babies, appears around day 6 or 7 and can last up to 2 months. It is harmless, and breastfeeding continues as normal unless the doctor says otherwise. But only a doctor can say that jaundice that drags on comes from the milk: they will check the colour of the stools in particular.

Bilirubin, phototherapy: what happens at the maternity unit

Before discharge, the team keeps an eye on the jaundice, often with a small device placed on the skin, with no needle, then with a blood test if the level looks high, as the CHUV in Lausanne and mpedia describe. In Canada, a check is planned at 72 hours of life, or at discharge if that comes sooner.

If the level goes above the thresholds set according to your baby’s age and weight, phototherapy is used. Your baby lies under a blue light, eyes protected, for a few hours to a few days; the NHS says about 48 hours for most babies. It is often done in the mother’s room, and breastfeeding continues. Transfusions have become exceptional.

If you leave the maternity unit early, ask when the jaundice should be checked: for babies discharged within 24 hours, the Canadian Paediatric Society recommends a bilirubin check 3 to 5 days after birth. Have the results noted in the health record, which you can keep in a health record holder, and reread our article on the first days at the maternity unit.

Why can jaundice be serious?

At a very high level, bilirubin can damage brain cells. In rare cases, severe jaundice can cause seizures, deafness, cerebral palsy or significant developmental delay, the Canadian Paediatric Society reminds us; mpedia calls this damage quite exceptional. That is why jaundice is measured rather than judged by eye, and why the signs in the table should not wait.

Pale stools: the sign never to ignore

White or putty-coloured stools can point to a problem with the liver or bile ducts, such as biliary atresia, and need urgent care, stresses Santé.fr. Naître et grandir describes the picture to watch for during the first weeks: darker urine, stools that grow pale, sometimes almost white, and a complexion turning green or coppery. Some of these illnesses can damage the liver irreversibly if they are not dealt with quickly.

So do not let yourself be reassured by the idea of jaundice that “lasts because he is breastfed”: at the slightest doubt about the colour of the stools, see a doctor the same day.

Does sunlight cure jaundice?

No. Putting a baby in the sun, behind a window or on the balcony, is still a widespread habit. Yet the Canadian Paediatric Society considers sun exposure, direct or indirect, potentially harmful and asks you to talk to a professional first. The French site mpedia, in an older page, accepts indoor daylight, but never direct sun. The NHS suggests no exposure at all.

Under the Moroccan sun, a newborn can quickly get too hot: our tips for protecting them from the heat apply from the very first days. Above all, sunlight replaces neither the measurement of bilirubin nor phototherapy, whose blue light is designed specially for this treatment: it only wastes time.