What Parents Should Know About Severe Jaundice

Causes, Risk Factors, and Treatments For Hyperbilirubinemia

Baby under lights in hospital
Jennifer Polixenni Brankin/Contributor/Getty Images

Bilirubin is a yellowish pigment formed in the liver by the breakdown of red blood cells. High levels of bilirubin can lead to jaundice, which is characterized by yellowing of the skin and eyes. Mild jaundice is a common condition in newborns because all babies go through a period of rapid red blood cell breakdown after birth.

Under these normal circumstances, mild jaundice typically disappears on its own, leaving no lasting effects. However, for some babies jaundice becomes severe, a condition known as hyperbilirubinemia. There are several reasons this might happen, such as being born prematurely or having certain medical conditions.

If not treated, severe jaundice can cause a type of permanent brain damage called kernicterus. Fortunately, this is rare.

As long as hyperbilirubinemia is diagnosed and treated right away, potentially devastating complications can be avoided.

Symptoms and Complications

When a newborn has jaundice, the condition is hard to miss: As the pigment circulates throughout the bloodstream the skin and whites of the eyes take on a yellow tint. The color sometimes begins on the face and then travels downward, to the chest, belly, legs, and soles of the feet.

Most babies develop some degree of jaundice within two to four days of birth. This condition, known as physiological jaundice, usually resolves within a couple of weeks. When jaundice is severe, however, an infant may develop other symptoms.

In fact, parents are typically instructed to keep an eye out for signs of severe jaundice after taking their newborn home from the hospital, including:

  • vomiting
  • lethargy
  • not feeding well
  • fever
  • having a high-pitched cry
  • dark urine or not enough wet or dirty diapers

When bilirubin levels become high enough to bring on these symptoms, a baby is at risk of developing kernicterus.

Causes and Risk Factors

There are a variety of reasons a baby might develop severe jaundice. The most common include:

In some cases, jaundice can be attributed to certain conditions that cause red blood cells to break down. These conditions include:

  • Erythroblastosis fetalis (a blood disorder)
  • Hemolytic anemia (a red blood cell disorder)


For all newborns, bilirubin levels are somewhat elevated during the first few days of life. Many hospitals check total bilirubin levels on all babies at about 24 hours after birth, often using a probe that can estimate the levels simply by touching the skin. 

The point at which a bilirubin level is dangerous changes with a baby's age. A level of 7 m/dL at 5 hours old is very concerning, but a level of 16 m/dL may be fine for a baby who is 4 days old. If a baby's bilirubin level is high, then blood tests are performed.


Severe jaundice is treated with phototherapy. The baby is placed underneath special blue lights—bili lights—in a warm, enclosed bed wearing only a diaper and special eye shades. It usually takes only a day or two of phototherapy in the hospital to bring bilirubin levels down to normal.

During that time frequent feeding—up to 12 times a day—is encouraged: With each bowel movement, more bilirubin is removed from the baby's system. In rare cases, a baby may receive extra fluids intravenously.

In the most severe cases of jaundice, an exchange transfusion is required as well. In this procedure, the baby's blood is replaced with fresh blood. Giving intravenous immunoglobulin to babies who have severe jaundice may also be effective in reducing bilirubin levels.

7 Sources
Verywell Family uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Centers for Disease Control and Prevention. What are jaundice and kernicterus?.

  2. Ullah S, Rahman K, Hedayati M. Hyperbilirubinemia in neonates: Types, causes, clinical examinations, preventive measures and treatments: A narrative review articleIran J Public Health. 2016;45(5):558–568.

  3. Centers for Disease Control and Prevention. Jaundice and kernicterus guidelines and tools for health professionals.

  4. Basu S, Kaur R, Kaur G. Hemolytic disease of the fetus and newborn: Current trends and perspectivesAsian J Transfus Sci. 2011;5(1):3–7. doi:10.4103/0973-6247.75963

  5. Jangaard K, Curtis H, Goldbloom R. Estimation of bilirubin using BiliChek, a transcutaneous bilirubin measurement device: Effects of gestational age and use of phototherapy. Paediatr Child Health. 2006;11(2):79-83. doi:10.1093/pch/11.2.79

  6. Merck Manual, Professional Version. Neonatal Hyperbilirubinemia.

  7. Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation. Pediatrics. 2004;114(1):297-316. doi:10.1542/peds.114.1.297

By Cheryl Bird, RN, BSN
Cheryl Bird, RN, BSN, is a registered nurse in a tertiary level neonatal intensive care unit at Mary Washington Hospital in Fredericksburg, Virginia.