Jaundice in Preemies

How the Relatively Normal Condition Can Turn Serious

A premature baby having light therapy.
A premature baby undergoing phototherapy to treat jaundice. BSIP/Universal Images Group/Getty Images

Jaundice is one of the most common health conditions seen in newborns, both premature and those born at term. Jaundice is characterized by the yellowing of the skin and eyes which happens when red blood cells break down and flood the body with a yellowish byproduct known as bilirubin.

In most babies, jaundice is perfectly normal and no cause for alarm. Newborns will commonly go through a short period where red blood cells will rapidly break down before eventually normalizing. However, in some cases, prolonged jaundice may be a sign of serious problem requiring immediate medical care.

Danger Signs

After delivery, most babies are able to metabolize bilirubin quite easily and pass it in their stools before too much accumulates. Because premature babies have less are developed organs, bilirubins are often harder to metabolize. In such case, if the red blood cells break down faster than the bilirubin can be metabolized, it can lead to as serious buildup known as hyperbilirubinemia.

If left unchecked, excessively high levels of bilirubin can cause a severe form of brain damage known as kernicterus. Kernicterus is seen mainly in premature or sick newborns but can also occur in full-term babies. Early signs may include:

  • Persistent or worsening yellowing of the skin and eyes
  • Extreme fatigue
  • Difficulty waking up or sleeping
  • Problems feeding
  • Extreme fussiness, often accompanied by a high-pitch cry
  • Limpness or stiffness of the body
  • Unusual eye movements
  • Muscle spasms

If your baby experiences any of these symptoms, seek emergency care immediately. If left untreated, kernicterus can cause permanent neurological damage, including hearing loss, cerebral palsy, intellectual disabilities, and even death.


Thanks to modern diagnostics and treatment, jaundice rarely gets so bad as to cause kernicterus. Premature babies who are at risk will have their bilirubin levels closely monitored with either a blood test or forehead meter.

In addition to preterm birth, risk factors for hyperbilirubinemia include:

  • Having a sibling who was previously affected
  • Bruising or trauma caused by an instrumented delivery
  • Delay in passing the baby's first stool, called meconium

The most common way to treat jaundice is to use phototherapy lights (also known as "bili lights") which help the body break down bilirubin into a form which the body can excrete.

If phototherapy fails to normalize bilirubin levels, an exchange transfusion may be needed during which some or all of the baby's blood is removed and replaced with donor blood. The procedure can be risky and requires an in-depth consultation to weigh both the pros and cons before providing parental consent.

A Word From Verywell

In most babies, jaundice is temporary and will be gone by around two weeks. All told, around 60 percent to 80 percent of newborns will experience some degree of jaundice, although it can be harder to see in babies with darker skin.

To aid in the removal of bilirubin, be sure to provide your baby with enough fluids in the form of breast milk or formula. Newborns should have at least six wet diapers per day, and their stool color should change from dark green to yellow if they are getting enough nutrition.

Meanwhile, direct sunlight should never be used as a form of at-home therapy as it can cause sunburn and serious injury to your newborn.

View Article Sources
  • Okumura, A.; Kidokoro, H.; Shoji, H. et al. "Kernicterus in Preterm Infants." Pediatrics. 2009; 123, e1052-e1058. DOI: 10.1542/peds.2008-2791.
  • Punnoose, A.; Schwartz, L.; and Golub, R. "Neonatal Hyperbilirubinemia." JAMA. 2012; 307(19):2115. DOI: 10.1001/jama.2012.4070.