Jaundice in Preemies

Causes, Treatments, and Effects of Jaundice in Premature Babies

A premature baby having light therapy.
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What is Jaundice?

Jaundice is one of the most common health problems in babies, both premature babies and babies born at term. Jaundice is the yellowing of skin and eyes that happens when red blood cells break down and bilirubin, a byproduct of red blood cell breakdown, floods the body.

In most babies, jaundice is normal. All babies go through a period of rapid red blood cell breakdown after birth and may look a little yellow.

In some babies, though, jaundice is more severe. Without treatment, serious consequences can occur.

Why is Jaundice Dangerous?

Most babies are able to metabolize bilirubin easily and pass it in their stools before too much builds up in the blood. In some babies, though, red blood cells break down faster than normal or the body can't metabolize bilirubin well. In those babies, bilirubin builds up to dangerous levels in the blood.

When there is too much bilirubin in the blood, it can cause a type of serious brain damage called kernicterus. Historically, kernicterus has been seen primarily in premature or sick newborns or those with serious blood type incompatibility. It's extremely rare in full term healthy infants, but when kernicterus does occur, it can lead to long-term health problems, including:

As you can see, kernicterus is a very serious problem.

If your baby has very high bilirubin levels, doctors will want to treat him or her immediately.

How is Jaundice Treated?

Thanks to modern medicine, jaundice rarely gets so bad that it causes kernicterus. Babies who are at risk for severe jaundice will have their bilirubin level checked often, to make sure that it doesn't get too high.

Bilirubin can be checked with a blood test or with a forehead meter. If the level is starting to climb, the baby will be treated for jaundice.

The most common way to treat jaundice is to use special lights, called phototherapy lights or bili lights. The lights help the body to break bilirubin down into a form that the body can excrete. There has to be bilirubin in the blood for the lights to work, so they can only treat jaundice - they can't prevent it.

There are many different types of bili lights to treat jaundice. Bili blankets are soft, small lights that go under the baby. The baby doesn't have to wear eye covers and can be wrapped up and held or breastfed. Other types of phototherapy are more intense and require the baby to lay in an incubator or crib with just a diaper on while the lights shine on the baby. A baby using this type of phototherapy will need to wear eye shields to protect the eyes.

If phototherapy doesn't work well enough, the baby's bilirubin level will continue to go up. In rare cases, doctors will do an exchange transfusion on the baby. In an exchange transfusion, some or all of the baby's blood is removed and replaced with donor blood. Exchange transfusions are done slowly, with small amounts being removed and replaced at a time, but they are still risky.

Why Are Premature Babies at Risk for Severe Jaundice?

Jaundice is normal, and most babies have at least mild jaundice. In term babies, doctors usually won't treat jaundice at all unless the bilirubin level is very high or rising very quickly. Doctors are more careful with preemies and treat jaundice at lower bilirubin levels because preemies don't metabolize bilirubin well and can have long term effects of jaundice at lower levels.

In term babies, the liver, intestines, and bladder all work together to break down bilirubin and pass it out of the body. In preemies these systems are all immature, so premature babies have a harder time breaking down and excreting bilirubin.

Not only do preemies have a harder time metabolizing bilirubin, but they can have more severe health problems from lower levels of bilirubin. Preemies are at risk for kernicterus at even low bilirubin levels and can have permanent hearing or movement problems.

How Long Will Jaundice Last?

In most babies, jaundice is temporary and will be gone by about two weeks. It can be hard for parents to see their babies under phototherapy lights with their eyes covered, but it will pass quickly.

Some types of jaundice last longer than two weeks or can't be fixed by phototherapy. Anything that injures the liver can cause jaundice. Babies who can't take milk and need IV fluids for long periods of time can have damaged livers, and are at risk for a type of jaundice called cholestatic jaundice. Some exclusively breastfed babies may develop breastmilk jaundice, which can last for up to three months, but doesn't cause kernicterus and rarely requires treatment.


Maisels, M.J. & Watchko, J.F. "Treatment of Jaundice in Low Birthweight Infants." Archives of Disease in Childhood Nov. 2003; 88, F459–F463.

Okumura, A., Kidokoro, H., Shoji, H., Nakazawa, T., Mimaki, M., Fujii, K., Oba, H., & Shimizu, T. "Kernicterus in Preterm Infants." Pediatrics June 2009; 123, e1052-e1058.

Watchko, J.F. & Maisels, M.J. "Jaundice in Low Birthweight Infants: Pathobiology and Outcome." Archives of Disease in Childhood Nov. 2003; 88, F455-8

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