How to prevent jaundice in newborns: 3 safe and effective measures

Neonatal jaundice is a very common condition in the first days of life. Approximately 60% of full-term infants and 80% of premature infants may develop jaundice in the first week after birth. The main cause is related to the immaturity of the infant's liver, which allows bilirubin—a product formed when red blood cells break down—to accumulate easily in the blood. However, in some cases, excessively high bilirubin levels can cause severe neurological complications if not detected and treated promptly.

Therefore, preventing neonatal jaundice does not mean trying to eliminate jaundice completely, but rather, more importantly, recognizing the causes of jaundice in newborns, monitoring feeding, and early detection of abnormal signs. According to the American Academy of Pediatrics (AAP) guidelines, newborns should be screened for bilirubin using transcutaneous measurement or blood tests within 24–48 hours after birth or before hospital discharge. In this article, Tiptory helps parents understand the risk factors, how to monitor infants at home, and when to seek medical attention, especially when jaundice is difficult to detect with the naked eye.

Part 1: How to recognize and reduce the risk of jaundice in babies

Method 1: Blood tests help detect the risk of jaundice

Blood type and antibody screening during pregnancy

• During pregnancy, mothers should undergo ABO, Rh(D) blood typing, and abnormal antibody screening as directed by a doctor. This is an important step to detect the risk of maternal-fetal blood group incompatibility, one of the causes of jaundice in newborns related to early red blood cell destruction.

• Especially, if the mother is Rh-negative, the doctor may order additional monitoring and testing for the infant after birth to determine the Rh group and assess the risk of hemolytic disease due to Rh incompatibility. When maternal antibodies attack the infant's red blood cells, the bilirubin produced can increase and lead to neonatal jaundice.

• If the mother has blood type O, the infant may be at risk for ABO incompatibility. However, not all cases of type O mothers require a DAT test for the infant; the doctor will consider it based on antibody screening results, bilirubin monitoring, and other risk factors.

Assessing the risk of G6PD deficiency

• Deficiency of the enzyme glucose-6-phosphate dehydrogenase (G6PD) is a factor that can increase the risk of hemolysis and elevated bilirubin in newborns. This condition is hereditary and is often considered when infants develop unexplained jaundice or have an atypical course.

• Do not routinely request G6PD testing for all infants solely for neonatal jaundice prevention. The doctor will consider testing based on family history, clinical presentation, suspected causes, and the infant's bilirubin trajectory.

Bilirubin screening for infants after birth

• Tests during pregnancy help identify some risk factors but cannot predict all cases of neonatal jaundice. Therefore, infants still need to be assessed for risk and screened for bilirubin after birth.

• According to AAP guidelines, infants 35 weeks gestation or older should have transcutaneous bilirubin measured or a blood bilirubin test performed within 24–48 hours after birth or before hospital discharge if discharged earlier.

• For infants with risk factors such as mothers with abnormal antibodies, Rh(D) negative mothers, or infants with signs of hemolysis, the doctor may order a DAT (direct Coombs test) and determine the infant's blood type for a more accurate risk assessment.

What parents need to remember to prevent neonatal jaundice

• Preventing neonatal jaundice primarily involves early detection and proper monitoring, rather than attempting to completely prevent jaundice. Parents should:

  • Ask the doctor about blood type and antibody screening results during pregnancy.

  • Inform if there is a family history of severe jaundice or hemolytic disease in previous children.

  • Ensure the infant is screened for bilirubin at appropriate times.

  • Do not rely solely on skin color to assess the degree of jaundice, as visual observation cannot accurately determine bilirubin levels.

  • Seek early medical attention if jaundice appears within 24 hours after birth, spreads rapidly, or if the infant shows abnormal signs. NICE emphasizes that jaundice within the first 24 hours requires urgent medical assessment.

Method 2: Reduce the risk of premature birth to limit jaundice

Adequate prenatal care to reduce the risk of premature birth

• Premature infants, especially those born before 37 weeks of gestation, have a higher risk of neonatal jaundice because their liver and other organs are not yet fully mature. However, not all premature births can be prevented.

• Regular prenatal check-ups help doctors monitor the health of the mother and fetus, and detect early problems that may increase the risk of premature birth. Mothers should adhere to the examination schedule, tests, and prenatal care instructions provided by their doctor.

Avoid tobacco, alcohol, and harmful substances

• Do not smoke, use drugs, or drink alcohol during pregnancy. These factors can increase the risk of premature birth and affect the health of the fetus.

• Do not self-medicate, including over-the-counter drugs or supplements. If you are taking medication for a medical condition, consult your doctor before stopping or changing the dosage.

• Limit exposure to pollutants or toxic chemicals in the workplace and living environment. If there is a risk of exposure, discuss it with your doctor for guidance on appropriate protective measures.

Manage stress during pregnancy

• Prolonged stress can be linked to an increased risk of premature birth, especially when combined with overwork, lack of social support, or domestic violence.

• Pregnant mothers should maintain adequate rest, share difficulties with family, and seek medical support when feeling overwhelmed. If facing physical or emotional abuse, prioritize safety and seek support as soon as possible.

Prevent and treat infections

• Certain infections during pregnancy such as syphilis, herpes, cytomegalovirus (CMV), and toxoplasmosis can increase the risk of pregnancy complications, including premature birth.

• Undergo infection screening tests as indicated, practice good hand hygiene, eat thoroughly cooked food, and avoid exposure sources warned by your doctor.

• If fever, abnormal discharge, painful urination, genital lesions, or other signs of infection appear, pregnant mothers should seek medical attention instead of self-treating.

Understand neonatal jaundice prevention correctly

• Reducing the risk of premature birth is part of neonatal jaundice prevention, but it cannot guarantee that the infant will not develop jaundice. Even full-term infants can develop jaundice in the first days of life.

• After birth, parents still need to monitor the infant's skin color, feeding status, frequency of urination, and any abnormal signs. Jaundice appearing within the first 24 hours after birth, rapidly increasing jaundice, or accompanied by poor feeding, lethargy, requires early assessment by a healthcare professional.

• Most importantly, parents should not try to prevent the causes of neonatal jaundice using folk remedies or self-treatment. Bilirubin monitoring and infant care according to medical guidelines help detect cases requiring treatment early.

Method 3: Ensure adequate feeding for the infant to reduce the risk of jaundice

Breastfeeding does not necessarily mean the infant will have jaundice

• Neonatal jaundice is common in breastfed infants, but this does not mean breast milk is the cause of the condition. According to the American Academy of Pediatrics (AAP) guidelines, elevated bilirubin in breastfed infants in the first few days is often related to insufficient milk intake, leading to less frequent bowel movements and increased reabsorption of bilirubin.

• Therefore, preventing neonatal jaundice does not mean stopping breastfeeding. Breast milk is still recommended as it provides numerous benefits for both the infant and the mother.

Breastfeed early and frequently

• In the first few days after birth, mothers should:

  • Breastfeed early, preferably within the first hour after birth if the mother's and baby's conditions allow.

  • Breastfeed on demand, usually at least 8 times in 24 hours.

  • Monitor whether the infant latches well, sucks, and swallows effectively.

• Infrequent feeding can increase the risk of elevated bilirubin in newborns. The AAP notes that breastfeeding less than 8 times a day is associated with higher bilirubin concentrations.

Monitor signs of adequate feeding

• Parents should not solely rely on the feeling of "the baby has fed" but need to observe actual signs:

  • The infant is alert and has a good sucking reflex.

  • Audible swallowing during feeding.

  • The frequency of urination and bowel movements gradually increases in the first few days of life.

  • Weight is monitored and does not decrease excessively.

  • The mother does not experience significant pain during breastfeeding and milk supply gradually increases.

• If the infant feeds poorly, is sleepy during feeding, urinates infrequently, loses significant weight, or jaundice increases, parents should contact a doctor or lactation consultant to assess the infant's milk intake.

Do not supplement with formula on your own

• Not all jaundiced breastfed infants need additional formula. The AAP recommends not routinely supplementing formula for well-hydrated breastfed infants, and also not using water or sugar water to prevent or reduce bilirubin.

• In some cases, the doctor may consider temporary supplementation with expressed breast milk, donor breast milk, or formula if the infant is not feeding adequately, is dehydrated, has excessive weight loss, or bilirubin levels rise to a point requiring intervention. This decision should be made after a specific assessment of benefits and risks.

Continue monitoring jaundice after hospital discharge

• Neonatal jaundice is often mild and resolves on its own, but excessively high bilirubin can cause neurological damage. Therefore, ensuring good feeding must be accompanied by bilirubin monitoring and appropriate follow-up appointments.

• If the infant's jaundice is more pronounced, feeding poorly, is difficult to arouse, shows signs of dehydration, or jaundice appears within 24 hours after birth, the infant should be taken to a doctor immediately for bilirubin assessment and to find the cause of neonatal jaundice, rather than just continuing to monitor at home.

Part 2: Safe treatments for neonatal jaundice

Method 1: Early feeding to reduce jaundice

Breastfeed within the first hour after birth

• Early feeding is one of the ways to support neonatal jaundice prevention. The WHO and UNICEF recommend initiating breastfeeding within 1 hour after birth, if the mother's and baby's conditions allow. Early skin-to-skin contact also helps the infant start breastfeeding more easily.

• Colostrum, which appears in the first few days, though small in quantity, is rich in nutrients and protective factors. Early feeding helps the infant receive colostrum from the start and establish a regular feeding rhythm.

Breastfeed frequently on demand

• After initiating feeding, infants should be breastfed on demand, day and night. For newborns at risk of elevated bilirubin, the AAP recommends frequent feeding, at least 8 times in 24 hours.

• When infants receive enough milk, urination and bowel movements occur more regularly, contributing to the excretion of bilirubin through the digestive tract. This is why ensuring adequate feeding plays an important role in reducing the risk of neonatal jaundice.

Check if the infant is feeding adequately

• Do not solely rely on the time the infant spends at the breast to assess milk intake. Parents can monitor several signs:

  • The infant has clear sucking and swallowing actions during feeding.

  • The frequency of urination and bowel movements increases gradually in the first few days.

  • The infant is alert, has a good sucking reflex, and is not overly difficult to arouse.

  • Weight is monitored according to the guidance of healthcare professionals.

  • The mother does not experience unusual pain during breastfeeding.

• If the infant feeds weakly, has difficulty latching, falls asleep continuously while feeding, urinates infrequently, or loses significant weight, parents should report it to a doctor or lactation support staff for early assessment.

Seek expert support if the infant has difficulty feeding

• If the mother does not know how to help the infant latch correctly, seeking help from a lactation consultant or qualified healthcare professional can help improve feeding technique and the ability to receive adequate milk. The WHO also recommends that mothers receive practical support to establish and maintain breastfeeding.

• Skin-to-skin contact immediately after birth and early feeding support can facilitate the establishment of breastfeeding.

Do not self-supplement with water to prevent jaundice

• Parents should not give newborns water, sugar water, or other liquids for the purpose of treating neonatal jaundice. The AAP recommends against using water or sugar water to prevent elevated bilirubin or reduce bilirubin levels.

• If the infant is not feeding adequately or bilirubin levels rise to a point requiring intervention, the doctor may consider supplementing with expressed breast milk, donor breast milk, or formula depending on the individual case. This decision should be based on the infant's nutritional status, bilirubin levels, and health, rather than self-supplementing at home.

Continue monitoring jaundice after early feeding

• Early and adequate feeding is part of neonatal jaundice prevention, but it cannot prevent all cases of jaundice. Infants still need bilirubin monitoring and follow-up appointments, especially if there are risk factors.

• If the infant's jaundice appears within the first 24 hours, jaundice increases rapidly, feeding is poor, the infant is lethargic or difficult to arouse, parents should take the infant to a doctor for bilirubin assessment and to find the cause of neonatal jaundice instead of just continuing to monitor at home.

Method 2: Feed the infant frequently to reduce jaundice

Maintain regular feeding sessions in the first few days

• Frequent feeding helps ensure adequate energy and hydration for newborns, while also promoting regular urination and bowel movements to excrete bilirubin. This is an important part of neonatal jaundice prevention, especially in infants at risk of elevated bilirubin.

• For breastfed infants, the AAP recommends feeding on demand, at least 8 times in 24 hours in the first few days after birth. Do not try to prolong the time between feedings just to make the infant sleep longer.

If breastfeeding, prioritize frequent feeding

• Feeding less than 8 times a day is associated with higher bilirubin levels. Insufficient milk intake can lead to less frequent bowel movements, causing more bilirubin to be reabsorbed through the intestines.

• In the first few days, mothers can:

  • Feed the infant based on hunger cues instead of waiting for the infant to cry.

  • Ensure the infant latches correctly and has effective sucking and swallowing actions.

  • Monitor the frequency of urination, bowel movements, and weight.

  • Seek help from healthcare professionals or lactation consultants if the infant has difficulty latching or feeding inefficiently.

If formula feeding, also maintain appropriate intake

• Infants fed formula still need to be fed regularly and adequately according to their needs. Parents should prepare formula at the correct ratio according to product instructions and healthcare professionals' advice, without arbitrarily making it thicker or thinner.

• Do not force infants to eat more than they need. The key to preventing jaundice in newborns is to ensure the baby receives adequate nutrition and growth monitoring, rather than aiming for the same amount of milk for all infants.

Monitoring signs that the baby is receiving enough milk

• Some signs that help parents assess effective feeding include:

  • The baby makes swallowing sounds while feeding.

  • Urine output gradually increases in the first few days.

  • Stool gradually transitions from meconium to yellow stool.

  • Weight is monitored, and weight loss is within limits deemed appropriate by the doctor.

  • The baby is alert and feeds well.

• If the baby feeds poorly, is difficult to wake for feeding, has low urine output, excessive weight loss, or rapidly increasing jaundice, parents should contact a doctor. These could be signs that the baby is not receiving enough milk and needs early evaluation.

Do not arbitrarily supplement with formula just because the baby has jaundice

• Jaundice in newborns does not always require formula supplementation. If the baby is breastfeeding well and is adequately hydrated, the AAP does not routinely recommend formula supplementation solely to prevent hyperbilirubinemia.

• In cases where the baby is not feeding adequately, is dehydrated, has excessive weight loss, or bilirubin levels are nearing the treatment threshold, the doctor may consider expressed breast milk, donor breast milk, or formula depending on the specific situation.

• Do not give water or sugar water to the baby with the aim of reducing newborn jaundice. The AAP recommends against using these liquids to prevent or reduce bilirubin.

Remember that adequate feeding is only one part of jaundice prevention

• Early and frequent feeding can help reduce the risk of hyperbilirubinemia due to insufficient feeding, but it cannot prevent all cases of jaundice in newborns. Some infants may still develop jaundice despite feeding well, for example, due to blood group incompatibility or other causes.

• Therefore, parents still need to adhere to the bilirubin check schedule and postnatal follow-up appointments. If jaundice appears within the first 24 hours, increases rapidly, or is accompanied by poor feeding, lethargy, or difficulty waking, the baby should be examined to determine the cause of newborn jaundice and receive timely treatment.

Method 3: Do not use sunlight to treat jaundice

Do not self-expose infants to sunlight to reduce jaundice

• Light can help convert bilirubin into a form that is easier to excrete, but natural sunlight is not a safe treatment method for jaundice in newborns. The intensity and wavelength of sunlight constantly change, while newborns are very sensitive to ultraviolet rays, temperature, and dehydration.

• NICE recommends not using sunlight to treat hyperbilirubinemia in newborns. If bilirubin exceeds the treatment threshold, the method used is phototherapy with specialized artificial light sources, with controlled light intensity and spectrum.

Understanding phototherapy correctly

• Medical phototherapy uses light of appropriate wavelengths to transform bilirubin into forms that the body can excrete more easily, thereby reducing bilirubin levels in the blood.

• When treatment is needed, the infant is typically placed under a specialized therapeutic light, while temperature, hydration status, and bilirubin levels are monitored. The infant's eyes are also protected during treatment.

Do not apply home sun exposure remedies

• Parents should not apply the method of sunbathing jaundiced newborns for a few minutes each day with the aim of replacing treatment. In particular, children should not be left directly under the sun or have their clothes removed to increase the exposed skin area.

• Sun exposure can cause infants to suffer from skin burns, overheating, hypothermia or hyperthermia, and dehydration, while it is impossible to precisely control the amount of light needed to reduce bilirubin.

Prioritize bilirubin monitoring over skin color assessment

• The degree of jaundice in newborns cannot be accurately assessed by visual inspection alone. If jaundice is suspected, the infant needs to be evaluated by a healthcare professional and have bilirubin measured by an appropriate method. NICE emphasizes that determining bilirubin levels is the basis for deciding whether treatment is necessary.

• Parents should pay special attention if jaundice appears within the first 24 hours, spreads rapidly, or if the infant shows unusual symptoms. These are situations that require early medical evaluation.

Continue to feed the baby frequently

• When an infant has jaundice, frequent feeding is still very important. NICE recommends continuing to breastfeed frequently and waking the infant to feed if necessary. Ensuring the infant receives enough milk helps maintain adequate hydration and supports bilirubin excretion.

• Therefore, preventing neonatal jaundice should focus on ensuring adequate feeding, monitoring bilirubin, and early recognition of abnormal signs, rather than using sunlight as a home treatment.

When to take your baby to the doctor immediately

• Parents should contact a healthcare professional if:

  • Jaundice appears within the first 24 hours of life.

  • The skin or whites of the eyes are becoming increasingly yellow.

  • The baby feeds poorly, is difficult to wake, or becomes lethargic.

  • The baby has dark urine or very pale stools.

  • Jaundice persists or does not improve over time.

• These signs may be related to the cause of newborn jaundice and require evaluation, rather than just being handled with home remedies.

Part 3: Understanding the causes of jaundice in newborns

Note 1: Understanding jaundice in newborns correctly

How is bilirubin formed?

• Jaundice in newborns occurs when bilirubin accumulates in the blood, causing the skin and whites of the eyes to turn yellow. Bilirubin is naturally produced when old red blood cells are broken down. Subsequently, the liver processes bilirubin, metabolizes it, and helps the body excrete it primarily through stool. In newborns, the liver is still immature, so the bilirubin processing can be slower.

• This is why the causes of newborn jaundice are often related to a combination of a relatively high amount of bilirubin produced and the body's limited ability to excrete it.

Jaundice typically appears in the first few days

• Physiological jaundice usually becomes apparent around day 2–3 after birth, and most mild cases will improve on their own within about a week. Approximately 60% of full-term infants and 80% of premature infants may develop neonatal jaundice.

• However, the timing of its appearance is crucial. Jaundice within the first 24 hours after birth is not simply considered physiological jaundice and requires early bilirubin assessment to determine the cause, especially hemolytic conditions.

Do not assess the severity of jaundice by eye alone

• Skin color can help parents recognize jaundice in their baby, but skin color cannot be used to accurately determine bilirubin levels. Visual assessment can also be less accurate in infants with darker skin tones.

• When assessment is needed, healthcare professionals may use:

  • Transcutaneous bilirubin (TcB) measurement with a specialized device.

  • Total serum bilirubin (TSB) test when more accurate determination is needed or when transcutaneous measurements are close to the treatment threshold.

• According to the AAP, infants 35 weeks gestation or older should have a TcB or TSB measured within 24–48 hours after birth or before discharge if discharged earlier.

Do not use a fixed bilirubin level for all infants

• The notion that "bilirubin below 5 mg/dL is normal, above 5 mg/dL is high" in older content is overly simplistic and no longer appropriate for current treatment guidelines.

• Doctors must assess bilirubin based on the infant's age in hours, gestational age, and risk factors for neurotoxicity. Therefore, two different infants with the same bilirubin level may have different indications for monitoring or treatment.

When does jaundice require treatment?

• Most cases of mild jaundice in newborns do not require specific treatment and will gradually decrease as the baby gets older. However, excessively high bilirubin can cause acute bilirubin encephalopathy; if the damage is prolonged, it can lead to kernicterus, a long-term neurological complication.

• If bilirubin reaches the treatment threshold, the doctor may order phototherapy. This method uses specialized light, typically blue LED light with an appropriate wavelength, to transform bilirubin into a form that the body can excrete more easily.

• In cases of very severe hyperbilirubinemia or non-response to intensive treatment, the infant may require a blood transfusion. This is a specialized measure performed in a medical facility and is not a common option. Early detection and appropriate phototherapy significantly reduce the risk of requiring a blood transfusion.

What should parents do to monitor jaundice?

• To prevent neonatal jaundice and limit the risk of high bilirubin, parents should:

  • Feed the baby adequately and frequently.

  • Monitor feeding ability, urination, bowel movements, and weight.

  • Take the baby for bilirubin checks according to the hospital's or doctor's schedule.

  • Do not self-treat by sunbathing, giving water, sugar water, or herbal remedies.

  • Pay special attention if the baby is premature, feeds poorly, or has a family history of severe jaundice.

• If jaundice appears within the first 24 hours, increases rapidly, the baby feeds poorly, is lethargic, or is difficult to wake, the baby should be examined early to determine the cause of newborn jaundice and bilirubin level, instead of just continuing to monitor at home.

Note 2: Recognizing signs of jaundice in infants

Observe skin and whites of eyes

• The most easily recognizable sign of jaundice in newborns is the skin turning yellow, usually starting on the face and then potentially spreading to the chest, abdomen, arms, and legs as bilirubin increases.

• The whites of the eyes can also turn yellow. However, parents should not rely on the degree of skin yellowness to estimate bilirubin on their own, as visual observation cannot replace specialized tests or bilirubin measurements.

• If jaundice is suspected, especially when the yellow color increases rapidly or appears in infants under 24 hours old, healthcare professionals should be contacted for evaluation.

Pay attention to drowsiness and poor feeding

• Newborns often sleep a lot, but unusual drowsiness, difficulty waking to feed, or weak feeding can be a worrying sign when accompanied by jaundice.

• Parents should monitor:

  • Whether the baby wakes up on their own to feed.

  • Whether the baby latches or sucks effectively on the breast or bottle nipple.

  • Whether the baby sucks and swallows efficiently.

  • Whether the baby refuses to feed or feeds significantly less than before.

  • Whether the number of wet and dirty diapers is appropriate for the baby's age.

• If the baby falls asleep during feeding, parents can gently wake them by changing their diaper, practicing skin-to-skin contact, or removing a layer of clothing if needed. Do not shake the baby or use forceful methods to wake them.

Do not ignore jaundice accompanied by poor feeding

• Jaundice accompanied by poor feeding or difficulty waking should be paid more attention than jaundice alone. Infants who do not receive enough milk may have an increased risk of hyperbilirubinemia due to insufficient feeding, while high bilirubin can also make infants drowsy and feed more poorly. These two conditions can form a vicious cycle that needs to be detected early.

• Parents should not simply try to treat newborn jaundice at home but need to evaluate the cause and bilirubin levels when there are abnormal signs.

Take your baby to the doctor if warning signs appear

• Medical evaluation should be sought early if:

  • Jaundice appears within the first 24 hours after birth.

  • Jaundice spreads rapidly or darkens significantly.

  • The baby feeds poorly, refuses to feed, or is difficult to wake.

  • The baby is lethargic, floppy, or shows abnormal muscle tone.

  • The baby has an abnormal cry, a high-pitched cry, arching of the back, or episodes of apnea.

  • The baby shows signs of dehydration or low urine output.

• These abnormal neurological signs may be related to severe hyperbilirubinemia and require urgent medical attention.

Monitor your baby even after a postnatal check-up

• The fact that the hospital has checked bilirubin does not mean the baby cannot develop hyperbilirubinemia after returning home. Bilirubin levels often change during the first few days of life, so follow-up appointments or rechecks should be performed according to the schedule advised by healthcare professionals.

• The most effective way to prevent neonatal jaundice is to combine adequate feeding, monitoring for abnormal signs, and checking bilirubin at the right time. Parents should not wait until the skin is clearly yellow all over before taking the baby to the doctor.

Note 3: When jaundice in newborns becomes dangerous

Recognizing when bilirubin increases excessively

• Jaundice in newborns is very common, and most mild cases will resolve on their own. However, excessively high bilirubin can cross the blood-brain barrier and cause acute bilirubin encephalopathy; if the damage is prolonged, it can lead to kernicterus with long-term neurological sequelae.

• Rare but severe complications can include movement disorders, hearing impairment, developmental delays, and dental enamel abnormalities. Therefore, the goal of preventing neonatal jaundice is not just to recognize yellow skin but also to detect cases where bilirubin increases rapidly or reaches the treatment threshold early.

Recognizing warning signs

• Parents need to pay special attention if the infant has jaundice accompanied by one or more of the following symptoms:

  • Lethargy, difficulty waking, or poor feeding.

  • High-pitched cry or abnormal crying.

  • Changes in muscle tone, such as floppiness or increased tone.

  • Fever or unusual irritability.

  • Arching of the back, head tilted back, or seizure-like episodes.

• These may be signs related to acute bilirubin encephalopathy and require urgent medical evaluation.

Do not use a single bilirubin number for all infants

• Older content often cited 20 mg/dL as a threshold for deciding whether to supplement with formula or provide treatment. This understanding is inaccurate if applied to all infants.

• According to current AAP guidelines, the decision for phototherapy is based on the infant's age in hours, gestational age, bilirubin concentration, and risk factors for neurotoxicity, rather than a fixed number for all infants.

• Therefore, parents should not conclude that "bilirubin below 20 mg/dL is not alarming" or "from 20 mg/dL, a blood transfusion is definitely necessary." The doctor needs to interpret test results within the context of charts and specific clinical situations.

Understanding formula supplementation correctly

• Not all jaundiced infants need additional formula. The AAP recommends continuing to support breastfeeding while assessing the infant's milk intake, hydration status, and weight loss. Well-fed and well-hydrated breastfed infants usually do not routinely need formula supplementation solely due to jaundice.

• If an infant is not feeding adequately, has excessive weight loss, is dehydrated, or their bilirubin levels are approaching the treatment threshold, the doctor may consider supplementing with expressed breast milk, donor breast milk, or formula. This decision should be discussed with the parents, considering the benefits and risks of each option.

• Formula supplementation can help bilirubin levels decrease faster in some situations, but the potential impact on establishing and maintaining the mother's milk supply needs to be considered. Therefore, do not independently replace breastfeeding sessions without medical indication.

Seek immediate medical attention if there are abnormal signs

• Parents should take their infant to a medical facility immediately if jaundice is accompanied by significantly poor feeding, lethargy, difficulty waking, high-pitched crying, changes in muscle tone, arching, fever, or seizures.

• If jaundice appears within the first 24 hours after birth, the infant also needs early bilirubin assessment to determine the cause of newborn jaundice, especially hemolytic conditions. The AAP considers jaundice within the first 24 hours a significant risk factor that requires timely evaluation.

Monitor bilirubin, not just by visual observation

• Yellow skin color does not accurately indicate bilirubin levels. The AAP recommends that infants 35 weeks gestation or older undergo transcutaneous bilirubin measurement or blood bilirubin testing within 24–48 hours after birth or before discharge if discharged earlier.

• When detected early, infants can be closely monitored or treated with phototherapy when appropriate thresholds are met. In cases of very severe hyperbilirubinemia, more intensive measures such as exchange transfusion may be necessary. This is why postnatal monitoring plays a crucial role in preventing newborn jaundice and limiting neurological complications.

Properly monitoring jaundice at home

Check areas where jaundice is easily noticeable

• For infants with dark skin, recognizing newborn jaundice by observing the skin can be more difficult. Parents can pay attention to the whites of the eyes and oral mucous membranes, and take the infant for bilirubin assessment if jaundice is suspected.

• Do not attempt to determine the severity of jaundice by visual inspection alone. Skin color, room lighting, and skin pigmentation can all affect observational ability. Transcutaneous bilirubin measurement or blood tests remain more reliable for assessing bilirubin levels.

Avoid yellow clothing that can cause confusion

• Yellow clothing can make it difficult for parents to notice changes in the infant's skin color. When monitoring newborn jaundice, observe the infant under natural light or appropriate white light and check the skin and eyes at different times.

• However, clothing color only affects observation and is not a cause of newborn jaundice. The important thing is to monitor the infant's signs and perform bilirubin tests when indicated.

Absolutely do not give water to newborns

• Newborns do not need extra water to reduce jaundice or help with faster bowel movements. In the first few months, breast milk or properly prepared formula provides the necessary fluid for the infant.

• Giving water to an infant can lead to them receiving less milk and, in some cases, cause hyponatremia, a potentially dangerous condition for newborns. The AAP does not recommend using water or sugar water to prevent or treat hyperbilirubinemia.

Monitor signs of adequate feeding and hydration

• When preventing newborn jaundice, parents should pay more attention to the infant's feeding ability and excretion status than just observing skin color:

  • The infant feeds regularly with effective sucking and swallowing actions.

  • The number of wet diapers gradually increases in the first few days.

  • The infant is alert and can be woken up to feed.

  • Weight is monitored as advised by the doctor.

  • There are no signs of dehydration such as dry lips or mouth, or significantly reduced urination.

• If the infant feeds poorly or urinates little, it is necessary to notify healthcare personnel to assess the infant's milk intake and risk of dehydration.

Seek immediate medical attention if there are warning signs

• Parents need to seek immediate medical care if the infant is:

  • Lethargic or difficult to wake.

  • Significantly increased jaundice or deep yellow color.

  • Poor feeding, refusing to feed, or difficulty maintaining feeding sessions.

  • Showing signs of dehydration.

  • Jaundice appearing within the first 24 hours after birth.

  • Showing abnormal neurological signs such as high-pitched crying, arching, changes in muscle tone, or seizures.

• These symptoms may indicate significantly increased bilirubin or that the infant is experiencing another problem that needs assessment. Do not simply apply home remedies for newborn jaundice and wait for it to resolve on its own.

Remember that correct monitoring is more important than self-treatment

• Most cases of newborn jaundice are mild, but some infants may have rapidly increasing bilirubin and require treatment. Therefore, preventing newborn jaundice should focus on ensuring the infant feeds adequately, attending follow-up appointments, and checking bilirubin when indicated.

• Parents should not use water, sugar water, herbs, or sun exposure for self-treatment. When abnormalities occur, identifying the cause of newborn jaundice and bilirubin levels is a crucial step in choosing a safe treatment method.

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Content edited by: Rene Lee Nguyen.

Information consulted and verified by expert: Joseph Bennett.