Jaundice is common in newborns. When babies have jaundice, it usually goes away on its own, but in some cases, it can become severe and cause bigger issues. It can also occur in adults from specific disease.
Signs and Symptoms of Jaundice
- Very yellow or orange skin color
- Extreme fussiness
- Difficulty waking up
- Not sleeping
- Poor feeding
- Limited wet or dirty diapers
If your baby exhibits any of the following symptoms, seek emergency medical assistance:
- Inconsolable or high-pitched crying
- Arching their body like a bow
- Stiff, limp, or floppy body
- Unusual eye movements
- Change in skin color
- Flu-like symptoms, like fever and chills
- Dark urine
- Clay-colored stool
- Itchy skin
- Weight loss
- Blood in vomit or stool
- Tarry black stool
- Extreme abdominal pain and tenderness
- Sudden drowsiness, agitation, or confusion
- Easy bruising or bleeding, sometimes causing a rash of tiny reddish-purple dots or larger splotches
Causes and Risk Factors of Jaundice
There are a few different reasons babies might get jaundice. They include:
Breast Milk Jaundice This type of jaundice generally occurs in the baby’s second or later week of life. While it’s unclear the exact reason for breast milk jaundice, it’s thought that substances in the breast milk may hinder baby’s liver from properly processing bilirubin.
This occurs when the mother's blood type is O and the baby's blood type is A or B or the mother's Rh factor (a protein found on red blood cells) is negative and the baby is Rh positive.
G6PD deficiency is most common in males of African heritage.
“Infants of Mediterranean descent may also be at increased risk for G6PD deficiency,” explains David L. Hill, MD, adjunct assistant professor of pediatrics at the University of North Carolina School of Medicine in Chapel Hill. “But as long as doctors follow standard bilirubin monitoring guidelines, these issues shouldn’t overly concern parents.”
- Internal bleeding
- Blood infection (sepsis)
- Viral or bacterial infections
- Blocked or scarred bile ducts
- Red blood cell abnormality
- A condition that affects the liver, like cystic fibrosis, according to the March of Dimes
While jaundice is very common, there are several factors that can elevate a baby’s chance of getting the condition, including:
Sibling With Jaundice If you have one child that developed jaundice as a baby, there’s a higher chance that your other children will get jaundice as well.
- Reabsorption of a large hematoma (a collection of clotted blood underneath the skin)
- Hemolytic anemias, where blood cells are prematurely destroyed and removed from the bloodstream
- Medications, including acetaminophen, penicillin, oral contraceptives, chlorpromazine (Thorazine), and estrogenic or anabolic steroids
- Viruses, including hepatitis A, chronic hepatitis B and C, and Epstein-Barr
- Autoimmune Disorders
- Alcohol overuse leading to hepatitis
- Rare genetic metabolic defects
- Inflammation of the gallbladder
- Gallbladder cancer
- Pancreatic cancer
- Nonalcoholic fatty liver disease from risk factors including diabetes and obesity
How Is Jaundice Diagnosed?
Testing options include:
Light Meter Here, a light meter is placed on a baby’s head to check the transcutaneous bilirubin (TcB) level.
Blood Test The baby’s total serum bilirubin (TSB) level is tested after a small blood sample is taken from baby’s heel. According to the CDC, this is the best way to accurately measure bilirubin levels in an infant.
- Blood Tests Various blood tests may be utilized, including a complete blood count, blood cultures, liver enzyme tests, and hepatitis tests.
- Imaging Tests Ultrasonography of the abdomen is often used to detect blockages in bile ducts. A computerized tomography (CT) scan, magnetic resonance imaging (MRI), or other tests to evaluate the flow of bile through the liver may also be used.
- Liver Biopsy If viral hepatitis, drug use, or exposure to a toxin are suspected (or if a diagnosis is unclear), a biopsy may be required.
- Endoscopic Retrograde Cholangiopancreatography (ERCP) ERCP is a procedure that looks at the bile ducts through an endoscope, according to MedlinePlus.
- Laparoscopy (Rarely) Here, your doctor makes a small incision below the navel and inserts a tube fitted with a camera (laparoscope) to examine the liver and gallbladder. (If a larger incision is required, this procedure is then called a laparotomy.)
Prognosis of Jaundice
Duration of Jaundice
Treatment and Medication Options for Jaundice
- Additional Feeding Your doctor may advise more frequent feedings or supplementation.
- Phototherapy Here, the baby is undressed down to a diaper and put under special blue-green lights that help break down bilirubin in the skin so that it can be excreted.
- Blood Protein Transfusion When baby’s jaundice is related to blood type incompatibility with mom, an IV transfusion of immunoglobulin (IVIg) may be required. Immunoglobulin is a blood protein that can reduce the level of antibodies that are contributing to the breakdown of baby's red blood cells.
- Exchange Transfusion On rare occasions when severe jaundice doesn’t respond to earlier treatments, the baby may require what’s called an exchange transfusion of blood. Here, small amounts of blood are repeatedly withdrawn and then replaced with donor blood. This process helps dilute bilirubin and antibodies from the mother.
Treatment focus is always on the underlying causes. Taking cholestyramine by mouth can relieve itchy skin caused by jaundice, yet many patients do not have itchy skin.
Alternative and Complementary Therapies
Prevention of Jaundice
“Regular feeding can help bring the bilirubin level down, so be sure your newborn is going no longer than four hours between feeds,” says Dr. Hill.
- Avoid hepatitis infection
- If you drink alcohol, drink in moderation, or stop if you have a history of hepatitis or liver injury
- Avoid becoming overweight or obese
- Keep your cholesterol levels healthy
Complications of Jaundice
Kernicterus This condition, a type of brain damage, can occur in babies when severe jaundice goes too long without treatment. It can cause athetoid cerebral palsy and hearing loss, as well as issues with vision and teeth and sometimes intellectual disabilities.
- Trouble waking up
- High-pitched crying
- Poor feeding or sucking
- Arching the body like a bow
Research and Statistics: How Many Babies and Adults Get Jaundice?
BIPOC Communities and Jaundice
Asian Babies and Jaundice
Black Babies and Jaundice
In addition, “it can be more difficult to identify jaundice in darker-skinned babies,” says pediatrician Whitney Casares, MD, author of The New Baby Blueprint: Caring for You and Your Little One. That’s because melanin, the substance that adds color to our skin, can hide the yellow tone from bilirubin, the chemical that causes jaundice. This doesn’t mean it’s impossible to spot jaundice in darker-skinned babies. It simply means that it takes more effort. “Checking the gums or inner lips for a yellow hue can help, as can pressing down gently on the skin with a finger,” explains Dr. Casares. And jaundice can often show up in the whites of the eyes before anywhere else, including the gums. If there is any doubt, a bilirubin test should be ordered.
Related Conditions and Causes of Jaundice
- Liver infections from a virus (hepatitis A, hepatitis B, hepatitis C, hepatitis D, and hepatitis E) or a parasite
- Birth defects or disorders that makes it difficult for the body to break down bilirubin (such as Gilbert syndrome, Dubin-Johnson syndrome, Rotor syndrome, or Crigler-Najjar syndrome)
- Chronic liver disease
- Gallstones or gallbladder disorders
- Blood disorders
- Pancreatic cancer
- Bile buildup in the gallbladder due to pressure in the abdominal area during pregnancy
Resources We Love
Centers for Disease Control and Prevention
The CDC is the nation's health protection agency. Their website offers information about the signs, symptoms, diagnosis, risk factors, and treatment of jaundice.
Cleveland Clinic, a nonprofit academic medical center, is one of the largest and most respected hospitals in the United States and a leader in research, education, and health information. Their website offers information about the causes, symptoms, diagnosis, treatment, and prevention of jaundice in adults.
The nonprofit organization focusing on mothers and babies has information about the causes of jaundice, along with diagnosis and treatment.
Editorial Sources and Fact-Checking
- Jaundice and Kernicterus: What Are Jaundice and Kernicterus? Centers for Disease Control and Prevention. November 26, 2019.
- Jaundice in Adults. Merck Manual Consumer Version. January 2020.
- Jaundice in the Newborn. Merck Manual Consumer Version. May 2020.
- Adult Jaundice. Cleveland Clinic. July 23, 2018.
- Jaundice. CDC Breastfeeding. November 13, 2020.
- Jaundice in Newborns. Kids Health from Nemours. April 2019.
- G6PD Deficiency. Kids Health from Nemours. July 2018.
- Infant Jaundice Symptoms and Causes. Mayo Clinic. March 17, 2020.
- Newborn Jaundice. March of Dimes. April 2013.
- ERCP. MedlinePlus. March 27, 2019.
- Newborn Jaundice. MedlinePlus. January 1, 2020.
- Jaundice in Adults. American Family Physician. February 1, 2017.
- Jaundice in Newborns: Parent FAQs. HealthyChildren.org. June 19, 2017.
- Fakhri M, Farhadi R, Mousavinasab SN, et al. Effect of Natural Products on Jaundice in Iranian Neonates. Jundishapur Journal of Natural Pharmaceutical Products. January 8, 2019.
- Evaluation and Treatment of Neonatal Hyperbilirubinemia. American Family Physician. June 1, 2014.
- Jaundice in the Adult Patient. American Family Physician. January 15, 2004.
- Bentz MG, Carmona N, Bhagwat MM, et al. Beyond 'Asian': Specific East and Southeast Asian Races or Ethnicities Associated With Jaundice Readmission. Hospital Pediatrics. May 2018.
- Okolie F, South-Paul JE, Watchko JF. Combating the Hidden Health Disparity of Kernicterus in Black Infants: A Review. JAMA Pediatrics. July 6, 2020.
- Jaundice Causes. MedlinePlus. July 13, 2019.