Watch for the signs of newborn jaundice: yellow within 24 hours of birth, getting more yellow, can't be woken or won't feed, pale stool, and go to the hospital the same day

Cost

Registration plus a bilirubin test, within a few hundred yuan. A baby who needs blue-light treatment is usually kept in the hospital for about two days. The hard part is making the trip even when the baby seems fine.

What you get

The American Academy of Pediatrics' 2022 guideline says "more than 80% of newborns have some degree of jaundice." Too much bilirubin can cause acute bilirubin encephalopathy and kernicterus. The guideline says kernicterus is a "permanent, disabling neurological disease." Its signs include cerebral palsy with involuntary twisting of the hands and feet, being unable to look upward, poorly formed enamel on the baby teeth, and hearing damage. The guideline lists "jaundice appearing within 24 hours of birth" as a risk factor for developing severe jaundice. The UK National Health Service (NHS) gives parents two tiers. The first tier is to call emergency services or go straight to the emergency department. This tier is a baby with jaundice who is also sleepier than usual or can't be woken, won't feed, is limp or stiff, or has twitching. A baby with jaundice who is not yet 24 hours old also falls in this tier. The second tier is to make an appointment with a doctor as soon as possible. This tier is a baby more than 24 hours old whose jaundice is not getting better or is getting worse, with dark yellow or brown urine, or pale creamy stool. Globally, an estimated 480,000 (48万) newborns in 2010 had Rh hemolytic disease (caused by a mismatch between mother's and baby's blood types) or very severe hyperbilirubinemia. Of these children, 24% died and 13% developed kernicterus. Of the children who survived kernicterus, more than 83% were left with one or more impairments. Pale stool may be biliary atresia, and the Kasai operation must be done within 60 days for the outlook to be clearly better. From 2004, Taiwan printed a stool color card into every newborn's child health handbook. The share having the operation within 60 days rose from 60% in 2004 to 74.3% in 2005. In another Taiwan nationwide study, after the color card was introduced, the death rate of children with biliary atresia fell from 26.2% to 15.9%. This is a before-and-after comparison, not a trial with groups.

Notes

Blue-light treatment (phototherapy) uses a special light on the baby's skin to turn bilirubin into a form that is easy to excrete. Don't use sunbathing at home as a substitute: the American Academy of Pediatrics says it is hard to do sunbathing both safely and without sunburn, so it does not recommend it as treatment. Also don't give water or glucose water to bring the yellow down, which this guideline likewise expressly does not recommend. Judging by eye how yellow the baby looks cannot tell you how high the bilirubin is. The UK's NICE guideline says not to rely on the eye alone, and to test once if you are unsure. Babies born before 38 weeks, with a sibling who had blue-light treatment, or who haven't had enough breast milk, are more likely to get more severely yellow. For follow-up, go by the national basic public health service standards: within 1 week after discharge, health workers make a home visit. At 28 to 30 days after birth, there is a follow-up at the community health service center or township health center. Jaundice is checked at both. If the doctor scheduled a bilirubin recheck at discharge, go at the scheduled time. If a full-term baby is still yellow after more than 14 days, or a premature baby after more than 21 days, the NICE guideline calls for one test of conjugated bilirubin and a check on whether the stool is pale. Jaundice itself does not delay vaccines; see §20.3 (vaccines). For newborn screening, see §27.13 (heel-prick blood screening).

Evidence grade

B : Supported by research but without a precise number, or based on small or single studies.

Sources

1. Kemper AR, Newman TB, Slaughter JL, et al. (2022). Clinical Practice Guideline Revision: Management of Hyperbilirubinemia in the Newborn Infant 35 or More Weeks of Gestation. Pediatrics, 150(3), e2022058859. https://doi.org/10.1542/peds.2022-058859
2. NHS. Jaundice in babies（2026-03-24 审阅）. https://www.nhs.uk/conditions/jaundice-newborn/
3. NICE (2010, 2023 修订). Jaundice in newborn babies under 28 days (CG98), 1.2.6、1.7.1. https://www.nice.org.uk/guidance/cg98/chapter/Recommendations
4. Bhutani VK, Zipursky A, Blencowe H, et al. (2013). Neonatal hyperbilirubinemia and Rhesus disease of the newborn: incidence and impairment estimates for 2010 at regional and global levels. Pediatric Research, 74(Suppl 1), 86-100. https://doi.org/10.1038/pr.2013.208
5. Hsiao CH, Chang MH, Chen HL, et al. (2008). Universal screening for biliary atresia using an infant stool color card in Taiwan. Hepatology, 47(4), 1233-1240. https://doi.org/10.1002/hep.22182
6. Lee M, Chen SC, Yang HY, et al. (2016). Infant Stool Color Card Screening Helps Reduce the Hospitalization Rate and Mortality of Biliary Atresia: A 14-Year Nationwide Cohort Study in Taiwan. Medicine, 95(12), e3166. https://doi.org/10.1097/MD.0000000000003166
7. 国家卫生计生委 (2017). 国家基本公共卫生服务规范（第三版），0～6 岁儿童健康管理服务规范. https://www.nhc.gov.cn/ewebeditor/uploadfile/2017/04/20170417104506514.pdf

Translated from the Chinese original. Original book, section 20, tip 13. This section is about health and medicines. It is general information, not a substitute for a doctor’s diagnosis or prescription. Content may be out of date and rules differ by place. When you actually deal with an agency, a doctor or a court, follow what local officials, doctors and lawyers tell you. Disclaimer