Neonatal jaundice in newborns: Signs, causes, diagnosis and treatment in Bangladesh

What is neonatal jaundice?

Jaundice happens when a substance called bilirubin builds up in your baby's blood faster than their liver can clear it out. Bilirubin is a yellow pigment created when old red blood cells break down—something that happens constantly in everyone's body. Here are some facts:

• The liver normally processes bilirubin so it can be removed from the body.
• Newborns, though, start life at a disadvantage on two fronts.
• They naturally have more red blood cells than adults, and those cells break down faster, which means their bodies produce more bilirubin to begin with.
• At the same time, a newborn's liver is still maturing and simply isn't as efficient yet at filtering it out.
• The result, for many babies, is a temporary buildup that shows up as a yellow tinge to the skin and the whites of the eyes.

Symptoms of neonatal jaundice and how to check at home

The obvious sign of jaundice is a yellowish color to the skin and eyes, and it tends to follow a predictable pattern: it usually starts at the face and, if it worsens, moves downward to the chest, belly, arms, and legs. This isn't a diagnostic test, but it's a useful way to notice changes between pediatrician visits.

It is important since most babies go home within a day or two of birth, before jaundice typically peaks. Because yellow skin can be tricky to spot on a screaming newborn, especially in artificial lighting, pediatricians often recommend a simple home check:

• Find a well-lit room, ideally with natural daylight.
• Gently press a fingertip on your baby's forehead or the tip of their nose.
• Lift your finger and look at the skin underneath.
• If it looks yellow rather than its normal color before the blood flows back, that's a sign of jaundice.

Safety note: A visual check cannot show the actual bilirubin level. Contact a healthcare professional if you notice yellowing of the skin or eyes, particularly when the baby is feeding poorly or appears unusually sleepy.

Common causes of neonatal jaundice

Neonatal jaundice usually develops because a newborn’s liver is still maturing and cannot remove bilirubin efficiently. Other possible causes include premature birth, poor feeding, blood-group incompatibility, bruising during delivery, infection, G6PD deficiency and, less commonly, liver or bile-flow disorders.

• Physiological jaundice
• Poor milk intake
• Premature birth
• Blood-group incompatibility
• Bruising during delivery
• Infection
• G6PD deficiency
• Liver or bile-flow disorders

When to seek urgent medical care for neonatal jaundice

Contact a doctor promptly if your newborn appears jaundiced. Go to a hospital or neonatal emergency service without delay if jaundice develops during the first 24 hours or the baby is difficult to wake, unusually weak, feeding poorly, having an abnormally high-pitched cry, arching the body or experiencing seizures.

A pediatrician or neonatal care team can examine the baby, assess feeding and hydration, measure bilirubin and decide whether further testing or treatment is needed. Here are some signs:

How neonatal jaundice is diagnosed

If jaundice is suspected, your baby's doctor will measure bilirubin levels using one of two methods. Doctors interpret the result according to the baby’s exact age in hours because the assessment and treatment thresholds change as the newborn gets older.

This is why pediatricians pay close attention to timing, not just the bilirubin number itself. Prof. Dr. Salahuddin Mahmud is the best child doctor in Bangladesh who focuses on early diagnosis, safe treatment for neonatal jaundice, and long-term health support.

• Transcutaneous bilirubin test: A transcutaneous bilirubinometer is placed against the baby’s skin to estimate the bilirubin level. It is quick and does not require a blood sample.
• Serum bilirubin test: A blood sample measures the total serum bilirubin more precisely. The healthcare team may use this result to confirm the level, assess the bilirubin trend and make treatment decisions.

Treatment options for newborn jaundice in Bangladesh

Treatment for newborn jaundice depends on the baby’s bilirubin level, age, gestational age, symptoms and underlying cause. Mild cases may only need feeding support and monitoring, while higher bilirubin levels may require phototherapy or advanced hospital treatment.

Possible complications if jaundice goes untreated

In the vast majority of cases, jaundice resolves without any lasting effect. The reason doctors take high bilirubin levels seriously, though, is the small but real risk of complications if levels climb too high for too long.

• Extremely elevated bilirubin can cross into the brain and cause a condition called kernicterus, which can lead to permanent effects including hearing problems, movement disorders, and developmental delays.
• This is genuinely rare in babies who receive routine newborn checkups and timely treatment. It's the reason pediatricians recommend follow-up visits in the days after birth, especially for babies who go home within 24 to 48 hours.
• The takeaway isn't to be afraid of jaundice. It's to take follow-up appointments and red-flag symptoms seriously.

Risk factors for high bilirubin in newborns

Some babies are more likely to develop significant neonatal jaundice and may need closer monitoring after birth. Babies with one or more of these risk factors may need earlier bilirubin testing and closer follow-up by a paediatrician. Important risk factors include:

• Lower gestational age, particularly birth before 38 weeks
• Jaundice appearing within the first 24 hours after birth
• Poor feeding or difficulty breastfeeding
• Blood-group incompatibility between the mother and baby
• Rapid breakdown of red blood cells (haemolysis)
• A previous sibling who required phototherapy or exchange transfusion
• Bruising or a birth injury that increases red blood cell breakdown
• G6PD deficiency or certain inherited blood disorders

Neonatal jaundice prevention and care tips for parents

If breastfeeding is a struggle in the first few days, don't hesitate to ask a lactation consultant or your pediatrician for help. Poor feeding is one of the most common and most fixable contributors to prolonged jaundice. While physiologic jaundice can't always be prevented outright, there's a lot you can do to support your baby's recovery and catch problems early:

• Feed frequently: aim for 8–12 feedings a day in the first week, whether breastfeeding or formula-feeding.
• Watch diaper output. Regular wet and dirty diapers are a good sign bilirubin is being cleared.
• Follow the discharge plan: Attend the bilirubin or newborn follow-up appointment at the time advised by the hospital. The required timing depends on the baby’s age, bilirubin level and individual risk factors.
• Check your baby's color daily in natural light for the first one to two weeks
• Ask about your baby's specific risk factors before leaving the hospital, so you know what to watch for.

Consult Prof. Dr. Salahuddin Mahmud for newborn jaundice assessment

Jaundice during the first 24 hours, severe sleepiness, poor feeding, abnormal crying, body arching or seizures require urgent hospital assessment. Do not wait for a routine chamber appointment. Prof. Dr. Salahuddin Mahmud is a pediatric gastroenterology and hepatology specialist and a Professor in the Department of Pediatric Gastroenterology, Hepatology & Nutrition at Bangladesh Shishu Hospital & Institute.

His experience is particularly relevant when jaundice is prolonged or may be associated with liver function, bile-flow problems, infection or another underlying condition.

• Assessment of jaundice severity and warning signs
• Review of bilirubin test reports and feeding history
• Evaluation of possible underlying causes
• Guidance on phototherapy and treatment options
• Advice on follow-up care and monitoring
• Assessment of prolonged or recurrent jaundice
• Evaluation of liver and bile-flow related conditions when needed
• Referral for hospital care if urgent treatment is required