Many newborns turn yellow in the first week because the liver is still immature and red blood cells break down quickly, raising bilirubin. Most cases are harmless, but very high levels can damage the brain, so every baby is screened before going home.
Key symptoms
- Yellow skin and eyes, starting at the face and moving down
- Sleepiness and poor feeding
- Fewer wet and dirty diapers than expected
- Dark urine or pale stools in cholestatic jaundice
What you find on exam
- Look for jaundice in natural light by pressing on the skin
- Hydration, weight loss from birth weight and feeding
- Bruising or cephalohematoma that adds bilirubin
- Tone, alertness and cry; feel the liver and spleen
Tests
- Transcutaneous or total serum bilirubin plotted on an hour-specific chart
- Blood type, direct antiglobulin test and blood count for hemolysis
- Direct (conjugated) bilirubin if jaundice lasts past 2 weeks
- G6PD testing when family history or ancestry suggests it
Treatment basics
- Frequent feeding, 8 to 12 times a day, to boost stooling
- Phototherapy when bilirubin passes the treatment threshold
- Exchange transfusion for very high levels or signs of brain injury
- Intravenous immunoglobulin in selected cases of immune hemolysis
- Follow-up check within 1 to 2 days after discharge
Red flags
- Jaundice in the first 24 hours of life
- High-pitched cry, arching or a very floppy baby
- Pale stools or dark urine suggesting biliary atresia
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Sources: NCCPA PANCE Content Blueprint; NCSBN 2026 NCLEX-RN Test Plan; NBOME COMLEX-USA clinical presentations. Written by Making Synapses. Making Synapses is not affiliated with these organizations.