Newborn
When should prolonged jaundice in infants be investigated?
Short clinical summary
Jaundice lasting beyond two weeks in term infants, or three weeks in preterm infants, is considered "prolonged jaundice" and its cause should be investigated. The cause is often benign (for example related to breast milk), but findings such as pale stools and dark urine suggest problems with bile flow and require prompt assessment.
Why does newborn jaundice occur?
Jaundice is the yellowing of the skin and the whites of the eyes caused by a rise in a substance called bilirubin in the blood. It is common in the newborn period: red blood cells have a shorter lifespan in babies, and the liver's capacity to process bilirubin has not yet matured in the first days.
Jaundice that appears in the first days of life and resolves within a few weeks is therefore an expected (physiological) process in most babies.
When is jaundice called prolonged?
Jaundice is defined as prolonged when it lasts beyond 14 days in term infants or 21 days in preterm infants. In this case the type of jaundice needs to be determined, because the underlying causes differ significantly.
The critical distinction: which bilirubin is raised?
The first step of assessment is determining whether the raised bilirubin is unconjugated (indirect) or conjugated (direct). An indirect rise is usually associated with benign causes. A raised direct bilirubin, however, suggests problems with bile flow and requires further assessment without delay.
Common causes
- Breast milk jaundice: One of the most common causes of prolonged jaundice. The baby feeds well, gains weight and is generally well.
- Jaundice due to inadequate feeding: Seen when sufficient milk intake is not established in the early days; weight gain is slow.
- Blood group incompatibility and haemolysis: More prominent in the early period after birth, but can contribute to jaundice persisting.
- Thyroid dysfunction: Requires review of the newborn screening results.
- Urinary tract infection: Can cause jaundice without other symptoms, and may therefore be investigated.
- Problems with bile flow: Less common, but early diagnosis is critical.
What assessments are carried out?
Assessment is individualised for each baby. In general it proceeds with history (gestational age, blood groups, feeding method, weight gain), physical examination, enquiry about stool and urine colour, and blood tests where needed. Screening test results are also reviewed again.
Which tests are requested, and in what order, is determined by the physician according to the baby's clinical condition.
When should you seek care without delay?
Warning signs
- Pale, white or chalk-coloured stools
- Dark (tea-coloured) urine
- Jaundice lasting beyond two weeks or becoming deeper
- Failure to gain weight, marked reduction in feeding
- Excessive sleepiness, difficulty waking
- Fever, vomiting or abdominal distension
Frequently asked questions
What does prolonged jaundice mean?
Jaundice lasting beyond two weeks in term infants, or beyond three weeks in preterm infants, is considered prolonged jaundice and its cause should be investigated.
Should breastfeeding be stopped in breast milk jaundice?
The general approach is to continue breastfeeding. Stopping is not routinely recommended; the priority is ensuring effective and frequent feeding. The decision is made after medical assessment.
Does sunlight exposure cure jaundice?
Placing a baby in sunlight by a window or outdoors is not an effective treatment and carries risks of skin burns and temperature changes. When treatment is required, phototherapy delivered in hospital is used.
Does jaundice affect a baby's intelligence?
Jaundice with an ordinary course leaves no lasting problems. However, very high bilirubin levels can, if untreated, have effects on the nervous system. This is why monitoring and, where needed, treating jaundice matters.
References
- Guidelines on the diagnosis and monitoring of neonatal hyperbilirubinaemia.
- Jaundice chapters of current pediatric and neonatology textbooks.
- Published reviews on the differential diagnosis of prolonged jaundice.
- Newborn screening programme information from the Turkish Ministry of Health.
This content is provided for general information purposes and does not replace individual medical assessment, diagnosis or treatment.
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Author and medical reviewer
Ayça Sözen, MD
Specialist in pediatrics. Currently seeing patients at Acıbadem Ataşehir Hospital.