What are the causes of jaundice in a newborn baby?

Jaundice in newborn babies is a common condition, often noticeable by a yellowing of the skin and the whites of the eyes. This yellowing is due to an excess of bilirubin, a yellow pigment that is produced during the normal breakdown of red blood cells. Here are some of the primary causes of jaundice in newborns:

When should parents seek help?

Jaundice in the first 24 hours needs urgent assessment. Seek care promptly for worsening yellowing, poor feeding, difficulty waking or suspected dehydration. Call 911 if your baby cannot be awakened or is very weak. Report pale, gray or white stools to the clinician. See the AAP jaundice symptom checker.

Physiological Jaundice

• This is the most common type of newborn jaundice.
• It occurs because a baby’s liver isn’t mature enough to get rid of bilirubin in the bloodstream.
• Typically appears on the second or third day of life.

Breastfeeding Jaundice

• Can occur when a newborn does not get enough breast milk, either because of difficulty with breastfeeding or because the mother’s milk hasn’t come in yet.
• Not related to the composition of the milk itself.

Breast Milk Jaundice

• Occurs in some breastfed babies due to substances in the breast milk that can cause bilirubin levels to rise.
• Often begins around days 4–7 and can last several weeks. A clinician should assess persistent jaundice rather than assuming it is breast milk jaundice.

Blood Group Incompatibility (Rh or ABO Problems)

• If the mother and baby have different blood types, the mother’s antibodies might attack the red blood cells in the baby, leading to a sudden increase in bilirubin.
• Examples include Rh incompatibility and ABO incompatibility.

Hemolytic Diseases of the Newborn

• Conditions where blood cells are broken down at a fast rate, such as hereditary spherocytosis or G6PD deficiency.
• This increased breakdown of red blood cells leads to higher bilirubin levels.

Liver Problems

• Rare disorders like biliary atresia, where the bile ducts are blocked or absent, can cause jaundice.
• Other liver conditions can also contribute.

Infection

• Bacterial or viral infections can also cause jaundice in newborns.

Cephalohematoma or Significant Bruising

• A collection of blood under the scalp (cephalohematoma) or significant bruising from delivery can increase the breakdown of red blood cells.

Enzyme Deficiencies

• Certain enzyme deficiencies can lead to an increase in bilirubin production.

Metabolic Disorders

• Rare metabolic disorders can also interfere with the body’s ability to process bilirubin.

Diagnosis and Treatment

Jaundice is usually diagnosed through a physical examination and confirmed with a bilirubin level test. Treatment depends on the cause and severity of jaundice. Mild cases might not require any treatment, while more severe cases could need phototherapy (treatment with a special type of light) or other medical interventions.

Conclusion

It’s important for newborns with jaundice to be monitored by healthcare professionals to ensure that the bilirubin level doesn’t get too high, as extremely high levels can pose risks to the baby’s nervous system. In most cases, newborn jaundice is a temporary condition and resolves without long-term effects.

Testing, follow-up and sources

Skin color alone cannot show the bilirubin level. Babies should have a skin or blood bilirubin measurement before leaving the hospital. Ask when repeat testing and follow-up are due; timing depends on the result, age and risk factors. Treatment decisions belong to the baby’s clinician. Do not use sunlight as a substitute for prescribed phototherapy. Read AAP: jaundice in newborns.

Related: newborn breastfeeding frequency and newborn vision screening.