Newborn Jaundice Symptoms: And When To See A Doctor

If your baby’s skin looks a little yellow in the first few days, you’re not alone. Newborn jaundice affects nearly 60-70% of full-term babies and about 80% of premature babies in their first week, according to Indian Paediatrics. Most of the time it clears up by itself as the baby’s liver matures. Still, it helps to know what the symptoms look like and which signs mean you shouldn’t wait.

Newborn jaundice symptoms usually show after 24 hours of birth. The yellow tinge usually shows up on the face first, then moves down to the chest, belly and legs. But how yellow your baby looks doesn’t tell you how serious it is. Doctors look at several other things too, which is why this blog covers the symptoms and the warning signs no parent should ignore.

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What Is Newborn Jaundice?

Newborn jaundice (neonatal jaundice) happens when there’s too much bilirubin in a baby’s blood, turning the skin and the whites of the eyes yellow.

Bilirubin is a yellow pigment made when old red blood cells break down. Normally, the liver processes it, and the body gets rid of it. Newborns, however, break down and replace red blood cells much faster than older children or adults do, so they make more bilirubin. Their livers are also still developing and can’t clear it quickly enough. The bilirubin builds up, and the yellow colour appears.

Jaundice usually shows up in the first few days after birth. In many babies, it’s mild and fades as the liver catches up. But if the yellowing appears within the first 24 hours, or keeps getting worse, the baby needs to be seen by a doctor right away.

This matters because very high bilirubin can reach the brain and cause permanent neurological damage. That’s rare, but it’s why jaundice should never be brushed off.

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Common Newborn Jaundice Symptoms

The yellowing tends to build slowly, so it’s easy to miss at first. Look out for:

• Yellow skin that starts on the face and spreads to the chest, belly and limbs as bilirubin rises
• Yellow whites of the eyes
• Yellowing inside the mouth, especially the cheeks and under the tongue
• Trouble feeding, or being too sleepy to stay awake for feeds
• Unusual drowsiness and low responsiveness

The first three are the usual signs. The last two are more worrying, because they can mean bilirubin levels are very high.

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When Do Newborn Jaundice Symptoms Appear?

Timing tells you a lot about the cause.

Day 1 (first 24 hours): Yellowing of skin or eyes in the first 24 hours after birth is not normal. It can be a sign of red blood cells breaking down too quickly because of an underlying problem, so your baby needs medical assessment immediately.

Day 2 to 3: This is when physiological jaundice typically begins. It’s the normal kind, caused by the liver still maturing. You’ll mostly see it on the face and in the eyes.

Day 3 to 5: Bilirubin keeps rising and the yellow spreads to the chest, belly, arms and legs. In more severe cases, it can reach the palms and soles.

Day 5 to 7: In full-term babies, levels start to drop as the liver gets better at its job.

After week 1: The colour fades in the reverse order, leaving the legs first, then the arms, belly, chest and finally the face and eyes. Some babies stay slightly yellow beyond a week, and this is more common in breastfed babies.

If jaundice lasts longer than 2 weeks in a full-term baby, or 3 weeks in a premature baby, get your baby checked.

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What Causes Newborn Jaundice?

Jaundice develops when a baby makes bilirubin faster than the body can remove it. Several things can be behind that.

1. Physiological jaundice. This is the most common form of newborn jaundice. As the liver has not yet matured, it can’t process bilirubin efficiently. It appears after the first 24 hours and peaks around day 3 to 5.

2. Breastfeeding-related jaundice. There are two kinds. Breastfeeding failure jaundice happens when the baby isn’t getting enough milk, usually in the first week. Breast milk jaundice is caused by substances in the milk that can increase the production or reabsorption of bilirubin in the baby's body. It has a late onset and appears after 1 week of birth.

3. Blood group incompatibility. Sometimes the mother’s and baby’s blood groups don’t match (Rh or ABO incompatibility). The mother’s antibodies cross the placenta and attack the baby’s red blood cells, which raises bilirubin. This mismatch occurs in about 15-20% of pregnancies, but only 1-10% of those lead to jaundice. It always needs medical assessment and monitoring.

4. Premature birth. Around 12-13% of babies in India are born before 37 weeks. Their livers are less mature, so they’re more prone to jaundice. How closely they’re monitored and treated depends on gestational age and other risk factors.

5. Infections and underlying conditions. G6PD deficiency (a red blood cell enzyme disorder), heavy bruising during delivery, and infections can all interfere with how bilirubin is processed.

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Which Babies Are at Higher Risk?

Some babies need their bilirubin checked more often. The risk factors include:

• Premature birth or a lower gestational age
• Jaundice within the first 24 hours
• A sibling who needed phototherapy
• Blood group incompatibility or other causes of faster red blood cell breakdown
• G6PD deficiency or a family history of red blood cell disorders
• Poor feeding, low milk intake or heavy weight loss after birth
• Significant bruising, or a collection of blood under the scalp after delivery

Having a risk factor doesn’t mean your baby will get severe jaundice. It just means closer monitoring is a good idea.

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When Should You See a Doctor?

Take your baby to a doctor if:

• You notice yellowing of skin
• Your baby feeds poorly or can’t stay awake for feeds
• The urine is dark
• The stools are pale, chalky or white
• The jaundice lasts longer than expected
• Your baby seems unwell, or has fewer wet nappies than usual

If you notice any of these, go to the nearest emergency department and get your baby assessed as soon as possible.