Jaundice in premature babies and newborns is very common and refers to a condition characterized by yellowing of the baby’s skin and whites of the eyes. Within a couple of days of being born, more than half of all infants (especially preemies) will show signs of jaundice. In most cases, jaundice isn’t severe and typically resolves within a couple of weeks. That being said, it’s important to have your healthcare provider check your baby for jaundice since severe consequences can result if it’s left untreated. Let’s examine the symptoms, causes, and treatment of jaundice.

What Is Jaundice?

Jaundice occurs when bilirubin builds up in an infant’s body (hyperbilirubinemia). Bilirubin is a yellow substance the body produces when red blood cells disintegrate. During pregnancy, the mother’s liver clears bilirubin for the infant. After birth, the baby’s liver must clear the bilirubin on its own. If an infant’s liver isn’t mature enough, it may not clear the bilirubin efficiently. The bilirubin may then begin to accumulate in the infant’s body, causing that characteristic yellowing of the skin and eyes.

What Are the Symptoms of Jaundice?

Jaundice is usually first visible on the face and then progresses to the chest, belly, arms, and legs as bilirubin levels increase. It’s best observed in natural lighting, such as standing outside or in front of a window. Jaundice can be harder to spot on babies with darker skin, but the yellowing is still observable in the whites of their eyes and under their tongues.

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When Does Severe Jaundice In Babies Occur?

Most infants develop jaundice in their first few days after being born. This is due to the fact that, for most of them, it takes a few days for their liver to mature and become more efficient at clearing out the bilirubin. According to the Cleveland Clinic and the Centers for Disease Control (CDC), babies with the following risk factors may need closer monitoring and early jaundice management:

• Premature babies. Babies born before 37 weeks may have an immature liver that is unable to get rid of so much bilirubin.
• Babies with darker skin color. Jaundice may be missed or not recognized in a baby with darker skin color.
• Babies of East Asian or Mediterranean descent. In addition, some families inherit conditions (like G6PD deficiency) that make their babies more prone to jaundice.
• A sibling with jaundice.
• Babies experiencing feeding difficulties.
• A blood infection (sepsis).
• A different blood type than the mother. Women with an O blood type or Rh-negative blood factor might have babies with higher bilirubin levels.
• Bruising from birth complications. The healing of large bruises can cause high levels of bilirubin and your baby might get jaundice.
• Too many red blood cells.
• An insufficient oxygen level (hypoxia).
• A liver condition like biliary atresia.

How is Jaundice in Premature Babies and Newborns Diagnosed?

Your pediatrician will evaluate your baby for signs of jaundice while you’re both still in the hospital. They will examine them again around three to five days after birth. This is when a baby’s bilirubin level will be most elevated. 

Your baby’s doctor or nurse can calculate the baby’s bilirubin level by placing a light meter on your baby’s head. This test shows the transcutaneous bilirubin (TcB) level. If this level is high, the doctor or nurse will order a blood test to verify the results. They’ll prick your infant’s heel to collect a small sample of blood. The blood test shows the total serum bilirubin (TSB) level.

How is Jaundice in Premature Babies and Newborns Treated?

Most cases of jaundice are mild and don’t require additional treatment. Jaundice typically resolves on its own within a week or two as your infant’s liver continues to mature. Frequent feedings (10 to 12 times daily) can promote bowel movements. This helps the baby remove surplus bilirubin.

If your infant’s bilirubin level is especially elevated or continues to increase, your pediatrician may order a day or two of phototherapy. During treatment, your baby will wear only a diaper and a special mask to protect their eyes. They’ll be placed under special blue lights that help their liver remove excess bilirubin. This simple treatment can be done at the hospital or possibly even at home. It’s worth noting that placing the baby in sunlight is not recommended by the CDC as a safe way of treating jaundice. Occasionally, phototherapy is ineffective, and your pediatrician may need to order an exchange transfusion. With this treatment, some of your infant’s blood is substituted with donated blood.

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How Long Does Jaundice Last in Premature Babies and Newborns?

Jaundice in newborns is common, typically developing by the second or third day after birth. For breastfed babies, jaundice can last for a month or more. In formula-fed babies, it typically resolves on its own within a couple of weeks. In most cases, jaundice does not require additional treatment, but it’s still essential to have your baby’s bilirubin level evaluated. Elevated levels can lead to serious health issues if not treated immediately. These conditions include cerebral palsy, hearing loss, and kernicterus, a type of brain damage.

When Should I Contact My Pediatrician?

Call your baby’s pediatrician if their jaundice increases or persists for more than two weeks or if you notice any of the following signs:

• Baby’s skin turns brighter yellow or orange.
• Baby seems exceptionally lethargic or is difficult to wake for feedings.
• Baby is extremely fussy.
• Baby isn’t feeding well.
• Baby isn’t producing enough wet or dirty diapers.

Seek immediate or emergency medical attention if your baby is experiencing any of the following symptoms:

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

The Takeaway

While it’s natural to be a bit concerned if your baby looks yellow, jaundice is a very common (and very treatable) condition in newborns that typically resolves on its own. Your pediatrician will evaluate your infant’s bilirubin levels before leaving the hospital and again within the first few days after birth. Be sure to keep all scheduled doctor appointments. Though jaundice typically isn’t severe, it can become dangerous if not treated appropriately. If your baby’s symptoms seem to be getting worse, contact your pediatrician right away.

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