A common and generally harmless phenomenon

Jaundice, also known as neonatal jaundice or benign transient cholestasis of the newborn, is a normal condition related to the baby’s physiological adaptations after birth. It affects approximately 60 to 80% of newborns to varying degrees, without always causing a visible yellow complexion.

What is physiological jaundice?

At birth, babies have an excess of red blood cells relative to their size. This surplus leads to the natural destruction of hemoglobin, called hemolysis, which releases a yellow pigment called bilirubin. The immature liver has difficulty eliminating bilirubin, which then accumulates in the blood and tissues, sometimes coloring the skin or eyes.

Bilirubin is gradually eliminated through:

• the progressive work of the liver
• exposure of the skin to light, which helps transform bilirubin so that it can be more easily eliminated
• its elimination in the stool, which is often yellowish in color

Factors that can accentuate jaundice

Certain factors can accentuate jaundice:

• RH blood incompatibility between mother and baby
• breastfeeding (especially in the first few days, before lactation is established)
• other underlying medical conditions

Severe jaundice in the first 24 hours of life or jaundice that persists beyond two weeks, especially if accompanied by other symptoms, should be evaluated by a doctor.

Screening and evaluation

All babies are routinely screened between 18 and 72 hours after birth (Canadian Paediatric Society, 2022). This screening generally includes:

• a heel prick blood test to measure bilirubin levels, adjusted according to the baby’s age in hours
• sometimes, a non-invasive test using a transcutaneous device applied to the forehead or chest, which measures bilirubin through the skin. This method is reliable provided that the device is regularly calibrated and validated by comparison with blood test results

In some areas, these tests can be performed at home by nurses from the healthcare network. It is essential to take these measurements before any treatment, as visual assessment alone is not sufficient to judge the severity of jaundice.

Symptoms to watch for

A baby with jaundice may:

• be more sleepy than usual
• have lower muscle tone
• feed less vigorously

These signs are usually temporary and improve quickly with adequate milk intake and effective elimination of stools, which are often yellowish due to the excretion of bilirubin.

The yellowish coloration may persist for up to six to eight weeks without posing a risk, provided that the baby’s general condition is stable. To assess skin color, it is recommended to use natural light, as artificial lighting can distort the appearance.

Note: the head is often the last area to return to normal color, as it is more exposed to light, while the rest of the body is usually covered.

Pathological jaundice (hyperbilirubinemia)

When healthcare professionals say that a baby does not have jaundice, it means that the level of bilirubin in the blood is not high enough to pose a risk, particularly a neurological risk.

Conversely, if the level is too high in the first few days, this indicates hyperbilirubinemia, a more serious condition that affects around 10% of full-term and premature newborns. It requires close monitoring and may even require treatment.

Treatment of hyperbilirubinemia

When hyperbilirubinemia is diagnosed, measures are taken to quickly lower the bilirubin level. The main treatment is phototherapy, which involves exposing the baby, in a diaper, to a special light. This light modifies the bilirubin so that it can be more easily eliminated through the skin and stools.

Depending on the case, the following may also be used:

• a light blanket
• fiber optic pads with a pad and a portable illuminator, designed to increase the body surface area exposed to light

As light can dry out the skin, it is essential to ensure that the baby is well hydrated by increasing the number of feeds. This also stimulates bowel movements, which help eliminate bilirubin.

The level is usually checked after 12 hours of treatment to assess its effectiveness and adjust it if necessary.

Early jaundice: special cases

Jaundice can appear early in some babies, particularly:

• those of Asian, Indian, or Hispanic origin
• those with a medical condition such as congenital hypothyroidism, neonatal infection, liver disease, or blood disease

In these cases, an individualized assessment is necessary.

Jaundice in premature babies

Premature babies are more vulnerable because their livers are even less mature. They are often placed in an incubator with enhanced phototherapy, sometimes combined with light pads. This optimizes the elimination of bilirubin.

Tips to promote elimination

Here are some practices that naturally support the elimination of bilirubin:

• Practice skin-to-skin contact and stay with your baby
• Start breastfeeding as soon as possible and breastfeed frequently to stimulate milk production and keep your baby well hydrated
• Ensure a good latch and effective sucking for nutritious feedings
• Avoid commercial formula supplements unless medically indicated
• Monitor the baby’s first stools (called meconium, which are blackish-green in color) and urine, as well as daily elimination patterns
• Check the baby’s weight gain, which is an important indicator of their overall health

In summary

Neonatal jaundice is a common and generally benign condition. Thanks to systematic screening, adequate monitoring, and effective treatments such as phototherapy, it is well managed. If you have any doubts or persistent symptoms, it is important to consult a healthcare professional.

Marie Fortier
Baby specialist

Updated: April 2025.

References : 

• American Academy of Pediatrics (AAP). (2004). Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation. Pediatrics, 114(1), 297-316. Directives révisées en 2022. Repéré le 16 avril 2025 à https://publications.aap.org/pediatrics/article/114/1/297/71100/Management-of-Hyperbilirubinemia-in-the-Newborn-Infant

• Barrington, K. J., Sankaran, K., & Société canadienne de pédiatrie, comité d’étude du fœtus et du nouveau-né. (2007). Lignes directrices pour la détection, la prise en charge et la prévention de l’hyperbilirubinémie chez les nouveau-nés à terme et peu prématurés (35 semaines d’âge gestationnel ou plus) – Résumé. Paediatr Child Health, 12(5), 411-418. Repéré le 16 avril 2025 à https://doi.org/10.1093/pch/12.5.411

• Société canadienne de pédiatrie. (2025, mars). Directives de détection et de prise en charge de l’hyperbilirubinémie chez les nouveau-nés à terme et peu prématurés (à compter de 35 semaines d’âge gestationnel). Dre Edith Massé sur l’hyperbilirubinémie néonatale. Repéré le 16 avril 2025 à https://cps.ca/fr/documents/position/hyperbilirubinemie-neonatale