Jaundice: Causes, signs and treatment

What is Jaundice in Newborns?

Jaundice causes yellowing of the skin and the whites of the eyes due to elevated bilirubin levels in the blood. Bilirubin is a yellow pigment produced naturally when the body breaks down old red blood cells. In newborns, the liver is still developing and may not process bilirubin efficiently enough to clear it quickly.

Most cases are mild — classified as physiological jaundice — and resolve naturally within 2 to 3 weeks without lasting effects. It typically appears between day 2 and day 4 after birth, which distinguishes it from more serious forms that appear within the first 24 hours.

What Causes Jaundice in Babies?

The most common cause is physiological jaundice: a newborn's developing liver simply cannot process bilirubin fast enough to keep up with normal red blood cell turnover. This typically appears on day 2 to 4 and resolves without treatment.

Breastfeeding jaundice may occur in the first week if a baby is not feeding sufficiently. Infrequent feeding means fewer bowel movements, which is the body's primary route for eliminating bilirubin.

Less Common Causes

Blood type incompatibility between mother and baby — such as Rh incompatibility or ABO incompatibility — can cause the immune system to break down the baby's red blood cells faster than normal, leading to higher bilirubin levels.

G6PD deficiency, a genetic condition more prevalent in Southeast Asian populations including Malaysia, reduces the red blood cell's ability to resist breakdown. Newborn screening for G6PD is standard in Malaysian hospitals, and parents in Malaysia should be aware that it is among the more common causes of prolonged or severe jaundice in this region.

Infections, liver conditions, or other digestive problems may also elevate bilirubin and typically require investigation if jaundice is severe or appears early.

Signs & Symptoms of Jaundice

The most visible sign is yellowing of the skin, starting from the face and spreading downward toward the chest, abdomen, and limbs as bilirubin levels rise. The whites of the eyes may also appear yellow.

Additional signs that warrant closer attention:

• Baby appears unusually sleepy or difficult to wake for feeds
• High-pitched or abnormal cry
• Feeds poorly or shows little interest in feeding
• Dark yellow urine (newborn urine should be nearly colourless)
• Pale, chalky, or white stools — this may indicate a more serious liver-related condition

How to Check for Jaundice at Home

Gently press the tip of your baby's nose or forehead with one finger. When you lift your finger, if the skin appears yellow rather than its normal skin tone, consult your doctor.

Visual checks alone are not reliable, particularly for babies with darker skin tones, where yellowing can be harder to detect. A blood test measuring serum bilirubin remains the most accurate method of assessment.

When Should You See a Doctor?

Seek medical attention immediately if any of the following apply:

• Jaundice appears within the first 24 hours of birth
• Yellowing spreads below the navel or reaches the arms and legs
• Jaundice persists beyond 3 weeks in a full-term baby, or 2 weeks in a premature baby
• Your baby is difficult to wake, feeding very poorly, or has a high-pitched cry
• Stools are pale or chalky

Seek urgent care if bilirubin levels are measured above 15 mg/dL in full-term babies. Very high bilirubin that goes untreated can lead to kernicterus — a rare but serious form of brain damage that can cause hearing loss, cerebral palsy, and developmental problems.

How is Jaundice Treated?

Feeding to Reduce Bilirubin

For mild cases, the most effective first step is frequent feeding — 8 to 12 times per day. Feeding stimulates bowel movements, which is how the body eliminates bilirubin from the system. Whether breastfeeding or formula feeding, ensuring your baby feeds well and regularly is the single most important thing you can do at home.

If breastfeeding, continue nursing on demand and watch for signs that your baby is latching well and feeding effectively. If you are concerned about milk supply, speak to your paediatrician or a lactation consultant before supplementing.

Phototherapy

Phototherapy is the most common medical treatment for jaundice that requires intervention. It uses blue-spectrum light to break down bilirubin in the skin into a form that the body can eliminate more easily through urine and stool.

Conventional phototherapy uses an overhead light panel placed above the baby in a cot. The baby's eyes are protected with a soft mask, and the skin is exposed to maximise light contact.

Fibre optic phototherapy (bili blanket) wraps directly around the baby's body and can in some cases allow feeding and holding during treatment.

Treatment typically lasts 1 to 2 days, with bilirubin levels monitored through regular blood tests throughout.

Jaundice & Nutrition — What Parents Need to Know

Feeding plays a central role in how quickly bilirubin is cleared from a newborn's body. Whether breastfeeding or formula feeding, frequent feeds stimulate the gut, drive bowel movements, and eliminate bilirubin.

For breastfeeding parents, breastfeeding jaundice in the first week is usually a sign of insufficient feeding rather than a problem with breast milk itself. Nursing frequently — at least 8 to 12 times in 24 hours — typically resolves mild cases. Breast milk jaundice, a separate and less common condition appearing after day 5, is generally benign and does not require stopping breastfeeding.

For formula-fed babies, look for options that contain DHA and ARA to support brain development — particularly relevant where elevated bilirubin levels were present, as the brain is the organ most sensitive to bilirubin toxicity in newborns.

Always consult your paediatrician before switching or supplementing feeds during a jaundice episode.