Reason for jaundice

Newborn jaundice - Causes - NHS

Jaundice is caused by too much bilirubin in the blood. This is known as hyperbilirubinaemia.

Bilirubin is a yellow substance produced when red blood cells, which carry oxygen around the body, are broken down.

The bilirubin travels in the bloodstream to the liver. The liver changes the form of the bilirubin so it can be passed out of the body in poo.

But if there's too much bilirubin in the blood or the liver cannot get rid of it, the excess bilirubin causes jaundice.

Jaundice in babies

Jaundice is common in newborn babies because babies have a high number of red blood cells in their blood, which are broken down and replaced frequently.

A newborn baby's liver is not fully developed, so it's less effective at processing the bilirubin and removing it from the blood.

This means the level of bilirubin in babies is much higher than in adults.

By the time a baby is around 2 weeks old, they're producing less bilirubin and their liver is more effective at removing it from the body.

This means the jaundice often corrects itself by this point without causing any harm.

Breastfeeding

Breastfeeding your baby can increase their chances of developing jaundice.

But there's no need to stop breastfeeding your baby if they have jaundice, because the symptoms normally pass in a few weeks.

Some breastfed babies can have jaundice for as long as 12 weeks, but it's important that this is checked by a health visitor or GP so other more serious causes of jaundice can be ruled out.

The benefits of breastfeeding outweigh any potential risks associated with the condition.

If your baby needs to be treated for jaundice, they may need extra fluids and more frequent feeds during treatment.

See treating newborn jaundice for more information.

It's unclear why breastfed babies are more likely to develop jaundice, but a number of theories have been suggested.

For example, it may be that breast milk contains certain substances that reduce the ability of the liver to process bilirubin.

Newborn jaundice thought to be linked to breastfeeding is sometimes called breast milk jaundice.

Underlying health conditions

Sometimes jaundice may be caused by another health problem. This is known as pathological jaundice.

Some causes of pathological jaundice include:

• an underactive thyroid gland (hypothyroidism) (where the thyroid gland does not produce enough hormones)
• blood group incompatibility (when the mother and baby have different blood types, which are mixed during the pregnancy or the birth)
• rhesus disease (a condition that can occur if the mother has rhesus-negative blood and the baby has rhesus-positive blood)
• a urinary tract infection (UTI)
• Crigler-Najjar syndrome (an inherited condition that affects the enzyme responsible for processing bilirubin)
• a blockage or problem in the bile ducts and gallbladder (the gallbladder stores bile, which is transported by the bile ducts to the gut)

An inherited enzyme deficiency known as glucose 6 phosphate dehydrogenase (G6PD) could also lead to jaundice or kernicterus.

It's important to let your midwife, GP or paediatrician know if you have a family history of G6PD. Your baby's jaundice symptoms will need to be closely monitored.

Page last reviewed: 03 February 2022
Next review due: 03 February 2025

Jaundice in Newborns: Symptoms, Causes & Treatment

Overview

What is jaundice in newborns?

Jaundice in newborns is the yellow coloring in an infant’s skin. Jaundice occurs when bilirubin (pronounced “bil-ih-ROO-bin”) builds up in your baby’s blood. Hyperbilirubinemia is the medical term for this condition.

Bilirubin is a yellow substance your body creates when red blood cells break down. While you’re pregnant, your liver removes bilirubin for your baby. But after birth, your baby’s liver must begin removing bilirubin. If your baby’s liver isn’t developed enough, it may not be able to get rid of bilirubin. When excess bilirubin builds up, your baby’s skin may appear yellow.

Jaundice in infants is common. It’s usually not serious and goes away within a couple of weeks. But it’s important for your baby’s healthcare provider to check them for jaundice. Severe jaundice can lead to brain damage if it goes untreated.

What are the different types of newborn jaundice?

There are a few different types of jaundice in newborns.

Physiological jaundice

The most common type of jaundice in newborns is physiological jaundice. This type of jaundice is normal. Physiological jaundice develops in most newborns by their second or third day of life. After your baby’s liver develops, it will start to get rid of excess bilirubin. Physiological jaundice usually isn’t serious and goes away on its own within two weeks.

Breastfeeding jaundice

Jaundice is more common in breastfed babies than formula-fed babies. Breastfeeding jaundice frequently occurs during your baby’s first week of life. It happens when your baby doesn’t get enough breast milk. It can occur due to nursing difficulties or because your milk hasn’t come in yet. Breastfeeding jaundice may take longer to go away.

Breast milk jaundice

Breast milk jaundice is different than breastfeeding jaundice. Substances in your breast milk can affect how your baby’s liver breaks down bilirubin. This can cause a bilirubin buildup. Breast milk jaundice may appear after your baby’s first week of life and may take a month or more to disappear.

Other types of jaundice can occur if your baby has an unrelated medication condition.

How common is jaundice in newborns?

Jaundice in newborns is a very common condition. Up to 60% of full-term babies develop jaundice during their first week of life. As many as 80% of premature babies develop jaundice during their first week of life.

What are the signs and symptoms of jaundice in newborns?

The main sign of jaundice is the yellowing of your baby’s skin. You can see it best in natural lighting, such as in front of a window. It usually appears in your baby’s face first. The whites of your baby’s eyes and under their tongue may look yellow. As the level of bilirubin increases, the yellowing may move to your baby’s chest, belly (abdomen), arms and legs. Jaundice may be difficult to see if your baby has darker skin. But you should still be able to tell if your baby has jaundice by the color of their eyes and under their tongue.

Symptoms and Causes

What causes jaundice in newborns?

Jaundice happens when your baby’s blood has too much bilirubin. Bilirubin is a chemical your body makes when it breaks down old red blood cells. Your liver normally filters bilirubin from your blood. Your body gets rid of it when you poop.

If your baby’s liver hasn’t developed enough to get rid of bilirubin, it can start to build up. This buildup of bilirubin causes your baby’s skin to look yellow. Most babies develop jaundice in their first few days of life. This is because it takes a few days for your baby's liver to develop and get better at removing bilirubin.

Severe jaundice can occur if your baby has:

• A blood infection (sepsis).
• A different blood type than you.
• Bruising from a difficult birth.
• Too many red blood cells.
• A low oxygen level (hypoxia).
• A liver condition such as biliary atresia.

Diagnosis and Tests

How is jaundice in newborns diagnosed?

Your baby’s healthcare provider will check for signs of jaundice while you’re still in the hospital. Your baby’s bilirubin level will be highest when they’re three to five days old. It’s important that your baby’s healthcare provider checks them again within this time frame.

Your baby’s healthcare provider can estimate your baby’s bilirubin level by placing a probe on your baby’s head. This test shows the transcutaneous bilirubin (TcB) level. If this level is high, your baby’s healthcare provider will order a blood test to confirm the results. They’ll prick your baby’s heel to collect a small sample of blood. The blood test shows the total serum bilirubin (TSB) level.

The American Academy of Pediatrics uses a newborn jaundice level chart to determine if a baby needs treatment. The chart is based on your baby’s total serum bilirubin level and age.

Management and Treatment

How is jaundice in newborns treated?

Treatment for jaundice in newborns isn’t usually necessary. Mild levels of jaundice typically go away on their own as your baby’s liver continues to develop. This can take one to two weeks. Feeding your baby often (10 to 12 times a day) can encourage pooping (bowel movements). This helps your baby rid their body of the excess bilirubin.

If your baby’s bilirubin level is high or continues to rise, their healthcare provider may recommend phototherapy treatment. During phototherapy, your baby will be undressed and placed under special blue lights. They’ll wear only a diaper and a mask to protect their eyes. Phototherapy helps your baby’s liver get rid of excess bilirubin. The lights won’t harm your baby. Phototherapy treatment takes one to two days. If your baby’s bilirubin levels aren’t too high, you may be able to treat your baby with light therapy at home.

In rare cases when phototherapy doesn’t work, your baby’s healthcare provider may recommend an exchange transfusion. With an exchange transfusion, some of your baby’s blood is replaced with fresh, donated blood.

Prevention

How can I prevent jaundice in my newborn?

Jaundice in newborns is normal and usually can’t be prevented. You can reduce the risk that your baby will develop severe jaundice by feeding them often. Frequent feedings stimulate regular bowel movements which will help your baby get rid of the bilirubin.

• Breastfed babies: You should breastfeed your baby eight to 12 times a day during their first week of life.
• Formula-fed babies: You should give your baby one to two ounces (30 to 60 milliliters) of formula every two to three hours during their first week of life. Ensure at least eight feeds in a 24-hour period.

Also, make sure your baby’s healthcare provider checks your baby’s bilirubin level before you leave the hospital. Schedule a follow-up visit during your baby’s first week of life to have the bilirubin level checked again.

Outlook / Prognosis

How long does jaundice in newborns last?

Jaundice in newborns is normal. It usually develops by their second or third day of life. In formula-fed babies, jaundice typically goes away on its own within two weeks. In breastfed babies, jaundice can last a month or longer.

What is the outlook for jaundice in newborns?

Jaundice in newborns is common. For most babies, jaundice will get better without treatment within one to two weeks. But it’s important to have your baby’s bilirubin level checked. A high bilirubin level can lead to serious health conditions if it’s not treated immediately. These conditions include cerebral palsy, deafness and kernicterus, a type of brain damage.

Living With

When should my baby see their healthcare provider?

You should return for a visit with your baby’s healthcare provider shortly after leaving the hospital. Your baby’s bilirubin level will be at its highest when they’re between three and five days old. The timing of your visit will depend on your baby’s age when you left the hospital, their bilirubin level when you left the hospital and other factors.

When should I call my baby’s healthcare provider?

You should contact your baby’s healthcare provider if their jaundice increases or lasts longer than two weeks. Symptoms of severe jaundice may include:

• Your baby’s skin turns brighter yellow or orange.
• Your baby is very sleepy, including difficult to wake for feeds.
• Your baby is very fussy.
• Your baby isn’t nursing well or sucking from a bottle well.
• Your baby isn’t making enough wet and/or dirty diapers.

When should I go to the ER?

Call 911 or go to your nearest emergency room if your baby has a:

• High-pitched cry.
• Fever.
• Arched body (head/neck or heels bent back and body forward).
• Stiff, limp or floppy body.

What questions should I ask my baby’s healthcare provider?

Jaundice in your newborn can be alarming. It’s normal to have questions if your baby develops jaundice in the hospital or after you’ve left for home. Common questions you may want to ask their healthcare provider include:

• How can I tell if my baby has jaundice?
• What complications can occur from jaundice?
• Will my baby need treatment for jaundice?
• Can I treat my baby’s jaundice at home?
• Can phototherapy harm my baby?
• How long does it take for jaundice to go away?
• When should we return for a follow-up visit?

A note from Cleveland Clinic

You may be a little worried if your baby looks yellow, but jaundice is a very common condition in newborns. Your baby’s healthcare provider should check your baby’s bilirubin level before you leave the hospital and again within five days of birth. While jaundice is usually not serious, it can be dangerous if not treated properly. If your newborn baby’s jaundice hasn’t improved or seems worse, call your baby’s healthcare provider right away. They can give your baby another bilirubin test to ensure they’re on their way to good health.

types, causes, symptoms, diagnosis, treatment in children and adults

Jaundice is a syndrome in which the skin, mucous membranes and whites of the eyes turn yellow. This is not an independent disease, but only a manifestation of some kind of pathology. The reasons for the development of jaundice can be completely different.

What causes jaundice?

Jaundice occurs when there is too much bilirubin in the blood. It can be increased due to many factors: disorders in the liver, disorders of the outflow of bile (bile itself contains bilirubin) from the gallbladder and bile ducts, disorders of the blood, in which too many red blood cells containing bilirubin break down.

Bilirubin is a yellow substance formed during the breakdown of red blood cells that carry oxygen throughout the body. When red blood cells die, the liver filters their breakdown products from the bloodstream. But with pathologies (diseases of the liver itself and biliary tract, increased destruction of red blood cells), the liver may not keep up with this process, bilirubin accumulates, and the skin, sclera of the eyes and mucous membranes become yellow.

Get tested for bilirubin at CITILAB

• Total bilirubin
• Bilirubin direct (conjugated)

Types of jaundice

There are several types of jaundice, and depending on this, the mechanism of damage differs.

There are three types of jaundice:

1. Prehepatic (hemolytic) jaundice. Appears when too many red blood cells break down. This process is called hemolysis. When too many red blood cells break down at once, a large amount of bilirubin is released that the liver cannot handle. This happens, for example, with hereditary types of anemia, when a person's erythrocytes (red blood cells) have a special shape and are prone to more rapid destruction.
2. Hepatic (parenchymal) jaundice. This type is associated with damage to the liver, from which the filtering ability of the organ suffers, and too much bilirubin enters the bloodstream. This is possible with liver infections, hepatitis, cirrhosis.
3. Subhepatic (mechanical) jaundice. This type of jaundice occurs due to blockage of the bile ducts that connect the liver, gallbladder, and intestines.

The bile ducts are a series of tubes that look like blood vessels but are responsible for transporting bile from the liver to the gallbladder. If the obstruction does not allow the liver to remove excess bilirubin, serious malfunctions occur in its work, which in turn provoke jaundice. This happens due to gallstones, enlarged lymph nodes or tumors.

Symptoms of jaundice

From the name of the syndrome it is clear what constitutes the main symptom. With jaundice, the whites of the eyes, skin and other tissues of the human body turn yellow. Interestingly, the shade of yellow can suggest the type of jaundice. With hemolytic jaundice, the skin becomes pale and acquires a light yellow, lemon hue. With hepatic - orange. With mechanical jaundice, the skin darkens, becomes earthy, greenish in color.

Acute jaundice is usually accompanied by fever, chills, abdominal pain, flu-like symptoms, dark urine, and light-colored stools.

If jaundice develops as a result of a chronic pathology, there may be symptoms such as weight loss or pruritus. Jaundice caused by cancer of the pancreas or biliary tract may be accompanied by abdominal pain.

Jaundice in children

A common occurrence is neonatal jaundice. As in adults, childhood jaundice is associated with elevated levels of bilirubin in the blood, but in the vast majority of cases it does not pose a serious threat to life or health.

Jaundice is one of the most common syndromes faced by newborns. According to statistics, almost 60% of full-term children and 80% of those born prematurely (before the 37th week of pregnancy) have jaundice of varying degrees at birth. At the same time, 60-70% of this number are faced with a physiological, and not a pathological, form of jaundice. And only one in 20 babies has bilirubin in the blood so high that it needs treatment.

Symptoms of neonatal jaundice usually develop 2 to 3 days after birth and resolve without treatment by 2 weeks. Most hospitals screen children for jaundice before discharge. Despite the fact that jaundice in newborns usually goes away without medical attention, at the first symptoms it is necessary to show the baby to the doctor so that the specialist can determine the cause of the yellow sclera or yellow skin and give individual recommendations.

Jaundice is common in newborns because infants' red blood cells break down faster. In addition, a newborn's liver is not fully developed, so it does not remove bilirubin from the blood as efficiently as it does in an adult. Plus - the low content of bacteria in the intestines of newborns also affects the exchange of bilirubin, increasing its content in the blood. Usually, by the end of the second week of a baby's life, his liver begins to cope with the amount of bilirubin, and the indicator returns to normal.

Treatment is usually only recommended if tests show a very high level of bilirubin in the child's blood. In especially high amounts, bilirubin has a neurotoxic effect - that is, it can harm the baby's brain. The extent of the damage depends on the duration of the jaundice and the degree to which the bilirubin is elevated.

Phototherapy is often used to lower the baby's bilirubin levels. Light from a special lamp falls on the skin and converts bilirubin into a form that is more easily broken down by the liver. In rare and severe cases, exchange transfusion is used: the baby's blood is removed using a catheter and replaced with blood from a suitable donor. Most babies respond well to treatment and are discharged from the hospital within a few days.

Jaundice in adults

Jaundice in adults is less common than in children and can occur for many reasons, including:

• Hepatitis. This is an inflammatory disease of the liver, often caused by a virus. Hepatitis can be acute (completely curable) or chronic. Other causes of hepatitis: drugs, drugs, alcohol, autoimmune diseases. Such damage to the liver eventually leads to jaundice.
• Blocked bile ducts. These thin tubes carry bile from the liver and gallbladder to the small intestine. Gallstones and tumors can block the ducts.
• Pancreatic cancer: This is the 10th most common cancer in men and 9th in women.
• Blood disorders that cause rapid breakdown of red blood cells.

Gilbert's syndrome

Separately, it is worth highlighting Gilbert's syndrome, a common hereditary disease, also known as constitutional liver dysfunction and familial non-hemolytic jaundice. It does not require treatment, and many doctors do not consider it a disease and consider it as a variant of the norm and an individual feature. Gilbert's syndrome occurs in 1-5% of the population, depending on the region. It is associated with a defect in the gene that is responsible for the production of a liver enzyme. This enzyme binds indirect bilirubin.

In a third of carriers of Gilbert's syndrome, the pathology does not manifest itself throughout life. It is often asymptomatic and is only detected by a blood test for bilirubin. However, more pronounced symptoms are also possible: pain in the right hypochondrium, metallic taste in the mouth, flatulence, vomiting, general weakness and fatigue, loss of appetite, insomnia. The symptoms are varied, and often patients with Gilbert's syndrome experience low mood, irritability, and anxiety.

There is usually no specific treatment for Gilbert's syndrome. The patient needs to limit the amount of fatty foods in the diet, adhere to a healthy lifestyle and visit a gastroenterologist - he is the one who diagnoses and treats this disease.

Diagnosis and treatment of jaundice

A preliminary diagnosis can be made already by skin color, but we repeat that jaundice is not a disease, but a syndrome. Therefore, all further diagnostics after the initial examination will be aimed at identifying the cause of the symptoms.

In case of yellowing of the skin or sclera, the following tests should be taken:

• complete blood count;
• urinalysis;
• biochemical blood test, including a blood test for total bilirubin and direct bilirubin;
• urinalysis for total bilirubin and direct bilirubin;
• blood for antibodies to viral hepatitis.

The next step is hardware diagnostics. Ultrasound of the liver and biliary tract is often required. An MRI or tomography may also be ordered by a doctor.

Treatment is selected individually, depending on the causes of jaundice, the condition of the internal organs and the results of the studies. Jaundice has many types and manifestations, and its treatment is also varied.

Different types of jaundice are dealt with by different specialists: therapists, infectious disease specialists, hematologists, oncologists. Which specialist will become the main attending physician will be clear as a result of the examination. It is right to start the examination with the delivery of laboratory tests and contacting a therapist.

Jaundice in adults - causes, examination and treatment | Symptoms

Alcoholic liver disease
Signs: Slowly developing jaundice. History of heavy alcohol consumption. The appearance in men of female characteristics (loss of muscle tissue, smoothness of the skin, enlargement of the mammary glands, reduction of the testicles and growth of female pubic hair). Sometimes dropsy of the abdomen due to accumulation of fluid (ascites).

Blockade of the bile duct by gallstone, tumor of the pancreas or bile ducts
Signs: Dark urine and light in color, soft, voluminous, oily and unusually foul-smelling stools. Usually there is pain in the upper right side or in the center of the abdominal cavity. If the cause is a tumor, weight loss and sometimes chronic abdominal pain.

Cholestasis during pregnancy
Signs: Severe itching. Later appearance of jaundice and dark urine. Usually develops in late pregnancy.

Hepatitis (viral)
Signs: Symptoms that are observed before the development of jaundice (nausea, vomiting, loss of appetite, fatigue, constant pain in the upper right side of the abdomen, fever, sometimes joint pain).

Primary biliary cholangitis (an autoimmune disease that affects the small bile ducts inside the liver)
Signs: Symptoms that often occur before jaundice develops (fatigue, itching, dry mouth and dry eyes). Sometimes discomfort in the upper right side of the abdomen, blackening of the skin, and small yellow deposits of fat in the skin (xanthomas) or eyelids (xanthelasma).

Primary sclerosing cholangitis (scarring and destruction of small and large bile ducts)
Signs: Symptoms that occur before the development of jaundice (worse symptoms of fatigue, itching, pain in the upper right side of the abdomen).

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