Seeing your baby have yellowish eyes and skin can easily send parents into panic mode, especially if you’ve never seen it before.
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This yellow discoloration in a newborn is called jaundice, and it’s a common issue, says pediatric gastroenterologist Kadakkal Radhakrishnan, MD.
Jaundice is due to an elevated level of yellowish pigment in the blood called bilirubin that forms when the baby’s body breaks down excess red blood cells. Bilirubin is carried through the blood to the liver, where it’s tagged to a chemical and excreted into bile, the green pigment made by the liver. Then it moves out of the body as waste.
“When your new baby begins breathing after birth, the excess red blood cells your baby had while in the uterus are broken down,” explains Dr. Radhakrishnan. “This generates a higher level of bilirubin in all babies after birth.”
This higher load of bilirubin and the fact that many infant’s livers can’t get properly get rid of it cause newborns to have higher levels of it. Sometimes, premature birth or an underlying disorder may aggravate their jaundice.
While your first line of defense might be to worry about your baby’s jaundice, it’s normal for babies born at term to have at least some jaundice that affects their eyes and face. It shouldn’t cause any problems, though.
“It’s normal to worry at first, but keep in mind that it’s nothing to be concerned about,” says Dr. Radhakrishnan. “This is typically seen on the baby’s second or third day of life and is called physiological jaundice.”
Some breastfed babies may have more jaundice than babies who aren’t breastfed, but this shouldn’t be a reason to stop breastfeeding. If you have concerns about jaundice and questions related to breastfeeding, be sure to talk to your child’s doctor.
“If the jaundice is noticeable on the first day of your baby’s life or it affects the chest or abdomen, it’s a sign their level of bilirubin may be higher than normal,” he says. “In this case, your baby should be evaluated by their doctor.”
When the onset of jaundice occurs on the first day or if jaundice doesn’t quickly go away, the problem could be beyond physiologic jaundice. Other issues could include blood group incompatibility, infection in the bloodstream, certain viral infections, abnormalities of certain enzymes or the red cell membrane.
If your baby’s jaundice sticks around longer than one week of their life, then problems related to the liver that affect the flow of bile to the intestine will have to be considered. Though these problems are not common, the most common among them is biliary atresia, a disorder that leads to blockage in the bile ducts, which are the tubes that drain bile from the liver to the intestine. Talk to your baby’s doctor if the jaundice is prolonged.
“Often, elevated bilirubin doesn’t lead to any major health problems,” says Dr. Radhakrishnan. “However, very high levels or inadequately treated elevated levels may cause brain damage and the risk is higher for premature babies. But before you worry, know that this is uncommon.”
Most often, physiologic jaundice does not require treatment and will improve on its own.
“If jaundice spreads to the chest, abdomen, if your baby’s skin color looks more yellow or if you are concerned regarding your babies feeding or excess sleepiness, a pediatrician will need to check your baby’s bilirubin level,” he says. “The decision to treat is based on the level of bilirubin and the age of your baby. This decision should be made with the help of your child’s doctor.”
Placing the baby under light, called phototherapy, is the most common treatment to lower bilirubin levels – if the pediatrician considers it high enough to be treated. Phototherapy often requires hospitalization and a premature baby may need a more aggressive treatment than a full-term baby. .” “Although it’s rare, when severe jaundice doesn’t respond to other types of therapy, an exchange transfusion may be required,” says Dr. Radhakrishnan. “In this procedure, the baby’s blood is exchanged in small volumes, which dilutes the bilirubin and maternal antibodies. This requires close monitoring and needs to be done in a neonatal intensive care unit.”
“Occasionally, a jaundice vest, which is a portable phototherapy device, may be used for your baby’s bilirubin levels that are elevated but not considered high enough for hospitalization,” he says. “If the pediatrician approves, this blanket can be used at home while monitoring your baby’s bilirubin level.
Whether your newborn has physiological jaundice or requires more intensive treatment, it’s important your baby is eating well. When your baby eats well, it can help them have good bowel movements and makes sure bilirubin gets excreted through their intestine. For this reason, your doctor may advise supplementary feeding beyond breastfeeding.