Jaundice in newborns is a common condition that usually appears within the first few days after birth. Although most cases are physiological jaundice, which does not affect health and resolves on its own, some cases are manifestations of pathological jaundice, which can lead to serious complications such as cerebral palsy, developmental delay, and even death if not treated promptly. Therefore, distinguishing between the two types of jaundice is essential so that parents can proactively monitor and address the condition early for their child.
1. Distinguishing physiological jaundice from pathological jaundice
In newborns, jaundice can be divided into two main groups: physiological and pathological.
1.1 Physiological jaundice
This is a mild condition that is common and not dangerous. In full-term infants, physiological jaundice usually begins after 24 hours of age and resolves on its own within 7 days. In premature infants, this period may extend to 14 days.
For jaundice to be classified as physiological, an infant must meet all of the following criteria:
The infant is healthy
Jaundice appears after 24 hours of age
Bilirubin does not exceed the phototherapy threshold
Jaundice lasts < 2 weeks in full-term infants, < 3 weeks in preterm infants
The rate of bilirubin increase is ≤ 5 mg%/day or ≤ 0.2 mg%/hour
Typical signs include mild yellowing of the skin, usually limited to the face, neck, chest, and upper abdomen above the navel, without accompanying abnormal symptoms such as poor feeding, lethargy, or an enlarged liver/spleen. The rate of bilirubin increase does not exceed 5mg% every 24 hours, and the peak blood bilirubin level reaches below 12–15mg% in full-term infants.
In preterm infants, depending on gestational age, the peak blood bilirubin level may reach 12–15mg% on day 5.
The cause is that a newborn's liver has not yet fully developed its bilirubin metabolism function, leading to an increase in indirect bilirubin — a yellow pigment produced from the breakdown of red blood cells. Because infants have a high number of red blood cells that are continuously replaced, the amount of bilirubin also increases. In addition, there is increased reabsorption of bilirubin from the intestines due to insufficient feeding and delayed passage of meconium. As the liver gradually completes its function after about 2 weeks of age, this condition resolves on its own.
1.2. Pathological jaundice
Unlike physiological jaundice, pathological jaundice appears early — usually within 24 hours after birth — and presents with more severe manifestations. The infant may develop jaundice throughout the entire body, including the palms and soles. This condition lasts longer than 2 weeks in full-term infants and longer than 3 weeks in preterm infants.
Infants may also show abnormal signs such as lethargy, poor feeding, fever, and seizures. Test results show an abnormally high concentration of bilirubin in the blood. If not diagnosed and treated promptly, indirect bilirubin can penetrate the brain, causing permanent neurological damage or even death.
Some common causes of pathological jaundice include:
Maternal-fetal blood group incompatibility (ABO, Rh).
G6PD deficiency – hereditary hemolysis
Congenital infection
Polycythemia
Hemorrhage (cephalohematoma, subgaleal hematoma, etc.)
Delayed meconium passage, intestinal obstruction
Bilirubin metabolism disorders: Crigler-Najjar syndrome, Gilbert syndrome, etc.
2. Signs that indicate the infant needs to be examined
Parents should take their infant to a medical facility if any of the following signs appear:
Jaundice appears early, before 48 hours of age.
Jaundice covers the entire body, including the palms and soles.
Jaundice lasts more than 2 weeks (full-term infants) or more than 3 weeks (preterm infants).
The infant also shows signs such as poor feeding, lethargy, fever, pale stools, seizures, etc.
Jaundice can be detected with the naked eye in a well-lit area. If the infant's skin is pink or dark, parents can gently press a finger on the infant's skin for a few seconds and then release it: if the pressed area shows a clear yellow color, the infant has signs of jaundice.
3. Preventing neonatal jaundice
To reduce the risk of severe jaundice in newborns, the following measures should be taken:
Proper prenatal care: attend all scheduled prenatal check-ups to detect and treat pregnancy-related conditions early, reducing the risk of premature birth or infection transmitted from mother to child.
Early breastfeeding after birth: colostrum helps the infant pass meconium quickly, removing bilirubin from the body.
Keeping the infant warm and monitoring regularly: ensuring the infant does not become cold or hypoglycemic, and making it easier to detect abnormal skin signs.
There are 2 methods for treating pathological neonatal jaundice caused by elevated indirect bilirubin:
3.1. Phototherapy
This is a safe, highly effective, and widely used method. Phototherapy uses blue light. The light passes through the skin and converts bilirubin into a form that is more easily excreted through urine and stool. During treatment, the infant is left undressed (except for the eyes and genital area) and is regularly repositioned to optimize effectiveness.
3.2. Exchange transfusion
This measure is indicated in cases of severe jaundice that does not respond to phototherapy or that presents with signs of neurological damage.
Note: Morning sun exposure cannot replace treatment for pathological jaundice, as sunlight is weak and not effective enough during the brief exposure time typically used.
Parents should pay special attention — although jaundice is common, it should not be taken lightly. Close monitoring and timely medical examination are the keys to preventing dangerous complications and protecting the child's overall development from the very first days of life.