Jaundice in newborns

A common and generally harmless phenomenon

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Jaundice, also called neonatal icterus or benign transient cholestasis of the newborn, is a normal physiological adaptation after birth. It affects 60 to 80% of babies, to varying degrees, without always causing a visibly yellow complexion.

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What is physiological jaundice?

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At birth, a baby has an excess of red blood cells. Their natural breakdown (hemolysis) releases a yellow pigment, bilirubin. Since the liver is still immature, it does not eliminate it well: the bilirubin then builds up in the blood and the tissues, sometimes tinting the skin or the eyes.

Bilirubin is gradually eliminated thanks to:

• the liver's gradual work
• the skin's exposure to light, which helps transform bilirubin so that it is more easily eliminated
• its removal in the stools, which are often yellowish as well

Factors that can increase jaundice

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Certain factors can increase jaundice:

• Rh blood incompatibility between the mother and the baby
• breastfeeding (particularly in the first few days, before the milk supply is established)
• other underlying medical conditions

Marked jaundice within the 24 hours following birth, or jaundice that lasts beyond two weeks, especially if other symptoms are present, must be assessed by a health professional.

Screening and assessment

All babies are screened systematically between 18 and 72 hours after birth (Canadian Paediatric Society, 2022). This screening generally includes:

• a heel blood test to measure the bilirubin level, adjusted for age in hours
• sometimes, a transcutaneous test applied on the forehead or the chest, which measures bilirubin through the skin; this method is reliable if the device is calibrated regularly and compared with blood results

In some regions, these tests can be done at home by nurses from the health network. It is essential to take these measurements before any treatment, because visual assessment alone is not enough to judge how severe the jaundice is.

Symptoms to watch for

A baby with jaundice may:

• be sleepier
• have weaker muscle tone
• suck less vigorously

These signs are generally temporary and improve with a good milk intake and effective elimination of stools, which are often yellowish because of the excretion of bilirubin.

The colouring can last up to six to eight weeks without risk if the baby's general condition is good. To assess skin tone, it is better to use natural light, since artificial lighting can distort the impression.

Note: the head is often the last area to regain a normal colour, since it is more exposed to light while the rest of the body is covered.

Pathological jaundice (hyperbilirubinemia)

When health professionals say that a baby does not have jaundice, it means that the bilirubin level is not high enough to be a risk, particularly a neurological one.

Conversely, a level that is too high in the first few days points to hyperbilirubinemia, a more worrying situation that affects about 10% of term or premature newborns and that requires close monitoring, and sometimes treatment.

Treating hyperbilirubinemia

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When hyperbilirubinemia is diagnosed, interventions are put in place to bring the bilirubin level down quickly. The main treatment is phototherapy, where the baby, in a diaper, is exposed to a special light that transforms bilirubin so that it is more easily eliminated through the skin and the stools.

Depending on the need, the following may also be used:

• a light blanket
• fibre-optic pads with a cushion and a portable illuminator, which increase the body surface exposed

Since light can dry out the skin, it is essential to ensure good hydration by increasing feedings, which also stimulates stools and promotes the elimination of bilirubin. The level is generally checked after 12 hours of treatment to verify how well it is working and adjust it if needed.

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Early jaundice: special cases

Jaundice can appear earlier in some babies, in particular:

• those of Asian, Indian or Hispanic descent
• those with a medical condition such as congenital hypothyroidism, a neonatal infection or a liver or blood disease

In these situations, an individualized assessment is necessary.

Jaundice in premature babies

Premature babies are more vulnerable, because their liver is even less mature. They are often placed under intensive phototherapy, sometimes combined with light pads, in order to optimize the elimination of bilirubin.

Tips to help elimination

Certain practices naturally support the elimination of bilirubin:

• Practise skin-to-skin and stay together with your baby
• Start breastfeeding quickly and breastfeed often to stimulate the milk coming in and maintain good hydration
• Ensure a good latch and effective sucking
• Avoid commercial formula supplements, unless medically indicated
• Watch your baby's first stools (meconium, blackish-green in colour), the urine and the daily progress of elimination
• Check weight gain, an important indicator of good overall condition

In short

Newborn jaundice is common and generally harmless. Thanks to systematic screening, adequate monitoring and effective treatments such as phototherapy, it is well managed. If you have any doubt or if symptoms persist, it is important to consult a health professional.

References

• American Academy of Pediatrics (AAP). (2004). Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation. Pediatrics, 114(1), 297-316. Guidelines revised in 2022. Retrieved April 16, 2025 from https://publications.aap.org/pediatrics/article/114/1/297/71100/Management-of-Hyperbilirubinemia-in-the-Newborn-Infant
• Barrington, K. J., Sankaran, K., & Canadian Paediatric Society, Fetus and Newborn Committee. (2007). Lignes directrices pour la détection, la prise en charge et la prévention de l'hyperbilirubinémie chez les nouveau-nés à terme et peu prématurés (35 semaines d'âge gestationnel ou plus) – Résumé. Paediatr Child Health, 12(5), 411-418. Retrieved April 16, 2025 from https://doi.org/10.1093/pch/12.5.411
• Canadian Paediatric Society. (2025, March). Directives de détection et de prise en charge de l'hyperbilirubinémie chez les nouveau-nés à terme et peu prématurés (à compter de 35 semaines d'âge gestationnel). Dr. Edith Massé on neonatal hyperbilirubinemia. Retrieved April 16, 2025 from https://cps.ca/fr/documents/position/hyperbilirubinemie-neonatale

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