Jaundice (yellowing of the skin and eyes) is very common in newborns: around 60% of term babies and 80% of preterm babies develop it in the first week. Most cases are mild and settle on their own. But severe jaundice can cause kernicterus, permanent brain damage leading to cerebral palsy, deafness or death. It remains a significant cause of preventable newborn harm in sub-Saharan Africa and South Asia. Nurses and midwives are usually the first to notice it.
Why newborns get jaundiced
Babies break down red blood cells quickly after birth, producing bilirubin, and their immature liver can’t clear it fast enough. This is physiological jaundice, usually appearing after 24 hours and peaking around days 3–5. Jaundice is more concerning when it appears early, rises fast, is very high, or persists.
Red flags: escalate urgently
- Jaundice in the first 24 hours of life: always abnormal. Measure bilirubin within 2 hours (NICE).
- Jaundice spreading to the palms and soles.
- A baby who is sleepy, feeding poorly, floppy, or has a high-pitched cry, arched back or abnormal movements: possible signs of bilirubin affecting the brain. This is an emergency.
- Jaundice in a preterm or unwell baby.
- Jaundice lasting more than 14 days in term babies (21 days in preterm), or pale chalky stools and dark urine: may indicate liver disease (e.g. biliary atresia), which needs urgent assessment.
Risk factors
- Prematurity (less than 38 weeks).
- A previous sibling who needed phototherapy.
- Blood group incompatibility between mother and baby (Rhesus or ABO).
- G6PD deficiency: common in parts of Africa, the Middle East and Asia, and a major cause of severe jaundice. Exposure to naphthalene (mothballs), certain herbal remedies and some medicines can trigger haemolysis.
- Bruising, birth trauma, infection.
- Poor feeding or exclusive breastfeeding that isn’t going well.
Assessing jaundice
- Examine the baby naked, in good natural light.
- On darker skin, check the whites of the eyes, gums and palms, and press lightly on the skin to see the colour underneath.
- Don’t rely on visual inspection to estimate bilirubin level: it is unreliable, particularly on darker skin.
- Measure bilirubin: transcutaneous bilirubinometer (for babies over 35 weeks and over 24 hours old, within its range), or a serum bilirubin blood test.
- Plot the result on the treatment threshold graph for the baby’s gestational age and age in hours.
Phototherapy: nursing care
Phototherapy uses blue light to convert bilirubin into a form that can be excreted. Nursing care includes:
- Place the baby on their back, with as much skin exposed as possible (nappy on).
- Eye protection as per the device instructions.
- Check the distance and light intensity are correct.
- Monitor temperature: risk of overheating or cooling.
- Hydration and feeding: continue breastfeeding with short breaks from the light; support mothers to feed frequently.
- Repeat bilirubin as directed (often 4–6 hours after starting, then every 6–12 hours).
- Explain to parents what is happening and why, and encourage contact.
For very high or rapidly rising levels, an exchange transfusion may be needed in a specialist unit. Where electricity or equipment is limited, filtered sunlight phototherapy has been studied as an option in some settings, under clinical supervision. Do not simply place babies in direct sunlight at home as treatment.
Teaching parents before discharge
- How to check for jaundice, and the danger signs.
- Feed frequently (8–12 times in 24 hours for breastfed babies).
- Watch the colour of stools and urine.
- Avoid mothballs, herbal remedies and applying substances to the baby’s skin.
- Return immediately if the baby is very yellow, sleepy, or feeding poorly.
Related: Newborn resuscitation · Newborn vital signs
Based on NICE CG98 (Jaundice in newborn babies under 28 days), American Academy of Pediatrics 2022 guideline, and WHO newborn care guidance. Educational content: follow your local treatment thresholds.