Jaundice in Newborns & Bilirubin Levels

The presence of enough bilirubin for yellow pigment to be visible on the skin is called jaundice. Jaundice occurs in about 60% of healthy term infants.

Question

Dr. Greene, my 6-week old was diagnosed with breastfed jaundice when her bilirubin was taken at one week old. I am supposed to stop breastfeeding her for 24 hours (and give her formula) and am finding her resisting the bottle. Will the jaundice eventually go away and could there be any harm in not giving her the recommended 24-hour break from breastfeeding?
Cambridge, Massachusetts

Dr. Greene's Answer

This week, while I was putting up lights to decorate for the holidays, I bruised my arm. I can remember, as a young child, watching bruises transform through a series of colors before they eventually disappeared.

What Causes Jaundice

Hemoglobin, the red pigment in red blood cells, must undergo a succession of changes before the body can dispose of it. Specific enzymes from our great processing center, the liver, carry out each step. Bilirubin, the yellow pigment responsible for jaundice, is a normal component in the breakdown of hemoglobin. Adults often turn yellow when they have hepatitis because their livers aren’t able to process the bilirubin.

Every day, about 1% of our red blood cells expire, to be replaced by fresh, young ones ready to carry oxygen to supply the body. Our lifeblood is new every 4 months.

A low level of bilirubin (about 1 mg/dL) circulates throughout our bodies as part of this process. This concentration is too faint to be visible.

Even before babies are born, this renewing of the blood is taking place. The placenta carries away the bilirubin as it is formed to the mother’s liver to be processed. After babies are born, they enter a transition period as their livers begin to assume this responsibility. Often, their immature livers can’t quite keep up.

The presence of enough bilirubin for the yellow pigment to be visible is called jaundice. Jaundice occurs in about 60% of healthy term infants and 80% of those born prematurely. If the bilirubin concentration rises to about 5 mg/dL, the face takes on a yellow appearance. If the level reaches about 15 mg/dL, the yellow tint is visible from the head down to the midabdomen. At a level of 20 mg/dL, even the soles of the feet are yellow (note: these are approximations and a blood test is required to know the true bilirubin level).

Bilirubin is found throughout the body, not just in the skin. Under certain conditions, high concentrations of bilirubin are toxic to babies’ brains. This is very rare when the concentration is under 25 mg/dL, but at higher concentrations, an increased risk for permanent hearing loss, mental retardation, spastic quadriplegia, or even death exists.

Causes of Rising Levels of Bilirubin

Anything that increases the number of expiring red blood cells soon after birth makes jaundice more likely. This might include the pounding babies take during difficult births (sometimes they look like little prizefighters) or the scalp hematomas caused by vacuum-assisted deliveries (one of my children looked like the ultimate conehead!). Sometimes extra red blood cells applying for social security are the result of a blood-type incompatibility, delayed cord clamping, a congenital anemia, or an infection.

Anything that makes it tougher for the immature liver to process the bilirubin can also lead to jaundice, including prematurity, lack of oxygen, poor feeding, thyroid deficiency, a genetic enzyme deficiency, or a liver otherwise occupied with dealing with an infection.

Pitocin, a drug commonly used to induce delivery, is also associated with increased bilirubin levels.

Physiologic Jaundice

The most common type of jaundice is called physiologic jaundice, the normal increased bilirubin in babies whose livers can’t quite keep up with a slightly increased load of red blood cells. This usually becomes visible on day 2 or 3 and peaks somewhere between days 2 and 4 as the liver gains control of the situation. The bilirubin levels usually fall substantially by day 7. Sometimes, they reach a level at which treatment is needed (>15 mg/dL before 48 hours old, >18 mg/dL before 72 hours old, > 20 mg/dL anytime–in otherwise healthy term babies). Stopping nursing is not recommended for physiologic jaundice, although supplementing feeds with pumped breast milk or formula may be helpful.

Breast-feeding Jaundice

There are two types of jaundice that are related to breast-feeding. They are called breast-feeding jaundice and breast milk jaundice. Breast-feeding jaundice is common and is a jaundice that may occur in the first week of life in breast-fed infants. The cause is thought to be due to decreased milk intake leading to dehydration or low caloric intake. The incidence of breast-feeding jaundice may be reduced by increasing the frequency of feeding and refraining from using water to replace breast milk (Nelson Textbook of Pediatrics, WB Saunders, 2007).

Breast Milk Jaundice

Breast milk jaundice is far less common, occurring in about 2% of breast-fed term babies. Here it is often not visible until the baby is a week old and then reaches its peak during the second or third week. The exact mechanism by which breast milk causes jaundice is uncertain. Breast milk jaundice may be caused by enzymes in mom’s milk that allow bilirubin to be reabsorbed into the blood from the intestines or by fatty acids in mom’s milk that the baby processes as a priority over processing the bilirubin. Or there may be an as yet unidentified mechanism.

Whichever the cause, if the mother continues to nurse her baby, the jaundice will decrease and disappear on its own, but this may take 3 to 10 weeks. If the mother stops nursing for 1 or 2 days, substituting formula, the bilirubin levels will drop rapidly. They will not rise again when the nursing is resumed.

Permanent damage or ill effects from breast milk jaundice is extremely rare. Phototherapy (lights used to lower bilirubin) may be used if the level of bilirubin is above 20 mg/dL. In breast milk jaundice, stopping breast milk for 1 to 2 days can help the bilirubin level drop rapidly. However, pediatricians and neonatologists generally agree that most babies who are well enough to feed may continue to feed on breast milk. This is true even when the bilirubin level is high enough to require phototherapy.

Even as I’m writing this article, my body is silently at work healing the bruise on my arm. As surely as that bruise will be gone by the new year, if your daughter has breast-feeding jaundice, she too will soon take care of her “pigment problem” herself–whether or not you take a break from nursing.

Medical Review on: January 04, 2011
About the Author
Photo of Dr. Alan Greene
Dr. Greene is a practicing physician, author, national and international TEDx speaker, and global health advocate. He is a graduate of Princeton University and University of California San Francisco.
Get Dr. Greene's Wellness RecommendationsSignup now to get Dr. Greene's healing philosophy, insight into medical trends, parenting tips, seasonal highlights, and health news delivered to your inbox every month.
Showing
50
comments (94 total)
Add your comment

Recent Comments

Dear sir,
My baby girl is 5 days it looks some color is yellow i check her doctor and he advice to admit in hospital,they will give some special lights raise.
i admit in hospital they start her treatment and first report its total bilirubin is 14.5 after eight hour’s its level is 10.
doctor said it ok discharge from hospital and give medicine of sun drop for one month(doz for one drop daily) and give sun raise of early morning and after evening at sunset.
i am worried is that my baby is fine.
please advice.

my daughter-in-law was induced using Pitocin,, at 2 days old, baby was diagnosed with jaundice. levels dropped 1 day later, but now have gone up again. what is causing this. Also , baby was already in special care unit, because cord was twice wrapped around her neck.altho Dr. didn’t seem concerned.

Hi, Can you help me to understand below .

My Son having 6 days Old having Jaundice level as below , His weight was 3.640 KG at the time of Birth. and He got birth by 37 Week and 1 day.

Is it normal Jaundice or need any treatment ?.
Bilirubin total – 15.2
Bilirubin conjugated(diazo method) – 0.2
bilirubin unconjugated,indirect()calculation – 15.0

What’s the average bilirubin level for a 12 day old newborn? 200 – 300?
Over 300 is consider bad? Thanks!

Dear dr. Greene
I am an Asian background, I had my son at 35 weeks and 4 days. When we left the hospital his level was 9ml per dl. Now we are 9 days old and his level has reached 16mg per ml. He drinks about 20-30 ml of breast milk every 2hours, but 95% of the time he is sleeping even when feeding. I am very worried. The doctor told me to put him on formula for a day and redo his blood work. I know that it can get lethal. I am very scared, I feel he is even having trouble breathing now. Should I just take him to the emergency room?

Hi Yujia,
Thank you for writing in! Dr. Greene’s article says, “The incidence of breast-feeding jaundice may be reduced by increasing the frequency of feeding and refraining from using water to replace breast milk.” Have you thought about trying to feed him more often? Please let us know how he’s doing, and trust your instincts.
Hope that helps!
Alexandra (caring helper at drgreene.com, not a doctor)

Question, comment. My daughter had a baby boy on December 24, 2016. She was released with my grandson the following day at 8:00 p.m. She was told her baby borderlined a higher than normal bilirubin level. She was told to have him tested again with 48 hours. With all doctors and offices having different hours during Christmas, she got him in for a recheck on December 29th. His level was at 22. He was brought to the hospital at about 9:30 p.m. (because she didn’t get a call from the doctors office until this time) where he was immediately put under phototherapy. His levels dropped to 10.3 in 2 days and he was released.

My question is this. Since I know 25 is the critical level for neurological damage and at 5 days he was a 22 with really no indicator of what was going on in between, does this level generally slowly RISE over several days, or is there a chance at day 3 or 4, that his levels were higher than what is considered safe? Any insight on these levels and their fluctuations? thanks.

Hello,

My son is 17 days old, exclusively breastfeeding, and his bilirubin level is 11.8. He had lights at days 5-6 with a level at 21. I have recently been diagnosed with NASH and also have elevated liver enzymes. I am wondering if my decreased liver function might be causing an increase in my own bilirubin and if that can be transferred to the baby in my breastmilk?

I have twins one girl baby one boy baby, girl have my blood group. Her bilirubin’s level is 19 any problem… Please give me answer….

My son completes 3days and on 4th day he had jaundice test and his direct bilirubin is 10.6.S it okay?

Dear sir,
My baby is 17 days old and his direct bilirubin is 1.5mg/dl and indirect bilirubin is 15.8mg/dl.
Total bilirubin is 17.3mg/dl.
His day 6 total bilirubin was 16mg/dl.
He was given phototherapy for 1day at day 10.
Otherwise he is alert and healthy.
I am worried about his bilirubin level and his jaundice which is up to both thighs and arms. p
Please reply sir.

Sir i am amir my son is 11 days .her direct bilirubin is 1.6mg/dl and indrect bilirubin is 12.6 mg/dl total bilirubin is 14.2 mg/dl.my son colour is no yellow.we are very woried .plz gave me advice.whats better for my son.plz help me..

Respected Sir,
My baby billirubin total 13.4
And direct 1.2
Baby age : 3 :5days
Kindly suggeste me baby left in
Photo therapy.
Please confirm normal bilirubin’.

Hi Sir/Madam,

My son age is 1 month.he is having Bilirubin as 6.8 mg/dl and hepatitis is negative.Doctor Suggested some drops.
He is doing good and taking breast feeding.
When he was at 1 week old Bilirubin as 15.8 mg/dl.After giving photo therapy treatment it become 10.8.
Please suggest me how it will come down.I am little bit worried about it.

Thanks
Ravi

Dear sir
Vinodha
Sir jandes bilirubin drite 7.8 and
bilirubin dendrite 8.7
Total bilirubin 15.8 and 41 years old fmale in Laver jandes 1year hospital Madison in no quar

Place suggest me sir comform normal bilirubin

My baby 1 week check up his jaundice was 9.4 , today at his almost 2 week check up appointment it was 11.1 ? I’m confused as to why she said it was normal for his age

Kristen,

As babies grow the normal bilirubin level goes up. In other words, the correct target number changes in relationship to your baby’s size. This is because the amount of bilirubin your baby can process goes up.

Hope that helps,
@MsGreene

Hai sir/Madam
My name is Raju and I am 23 . actually my total serum bilirubin =1.62 mg/dt. It is in blood test.please suggest me is it normal or not.or else please say if any problem.

Hi Doctor, my son is 7 days old and bilirubin level is 19 . Is taking mother’s feed regularly.
Doctors have advised to admit him for photo therapy .
Please advice me ?

Hello Sir

my 6 weeks old son direct billirubin is 7.7 mg/dl
indirect is 0
At one week, it was 17 mg/dl

i am very tensed. what to do sir.
please suggest

Extremely helpful and clear information, thank you Dr. Greene, much appreciated.

I have one question regarding Breast milk jaundice, is there any type of food that the mom eats and might be causing jaundice?

My Age Is 49 And My Bilrubin level is 2.14 (totel)

Sir/Ma’m Any problem.?
Is it Dangerous.?

serum amylase value of a pt. is 400 u/l
after 5 days it became normal how

is it possible the values OF
B.T.-5.0 mg/dl,ALKP-525 u/l,AST-250 u/l,ALT-256 u/l became
B.T.-0.5 mg/dl,alkp-90 u/l ast-25 u/l alt-22 u/l after 15 days by using medicine

hi Dr green,my son is 9 days old,and bilirubin test results are direct 0.9 and indirect 15.4.
his physician is suggesting for admission to neonatal care unit.although his appearance is very normal,no yellowish tone in skin or eyes.
please advice

sir hii i am shiv i am 18 years old ,and iam hvng jaundice ,but i didn’t gone for blood test to know the percentage ,as adviced by my local Ayurvedaic guru
my symptoms r just yellow of eye and urine, itching also so i should i know my % level by not going to doctor
before i came to know the jaundice problem
i was having loose motion and pain in abdomen and burning sensation in stomach after eating food then i came to know my j-problem
so please reply sir
i am from India

What if a person has 7.2 bilirubin content in blood test. Does the person has affected with jaundice to maximum n in serious stage ? Sir/mam ur reply is valuable.

I am Amartya Saha I am suffering jaundice -hapatites a I am 13 yer now my bilirubin is 14.58mg/ul what will my treat ment and diet. sir I am waiting

I am Amartya 13yer at now my bilirubin is 14mg/ul who can I treat.

My son is one week old today n his bilirubin level is 12.1 mg/dl but the doctor said he didn’t need treatment. But he hasn’t been treated since he was a day old for one day n that’s it. But his levels are going up n down every time they check his level n I am breastfeeding him everyday. When do I need to do to get his bilirubin level low?

My son was treated with phototherapy for two days in the hospital before he was discharged on April 3, 3026. His bilirubin dropped from 20.1 to 10.4. He’s two weeks today, every time I look at him, he still looks yellow to me, but his doctor said that my son is find. I request for another bilirubin test but the doctor refused saying that it’s not necessary, and that I can get my baby sick by doing the test. So I’m so confused now, don’t know what else to do. I already scheduled to see a different Doctor is Monday for a second opinion. What do you think Dr. Greene?

My son is 1month old, his bilirubin is 13. What care should we take? This is first time bilirubin test was done.

Sir my son have bilirubin 3.5mg it normal or serios please give some advice

Hello sir my father have jaundice problem .the level is 20 how to cure from jandice.

Sir my S bilirubin range 1.74 sir its normal

My age 22 year old

My serum bilirubin level is 2.4 mg %. I am 21 year old.

My baby is one month old and bilibrium is 12 mg. What should i do?

Sir, I’m srinivas suffering vth jaundice from 20days my billrubin level is at 2.3 is it was at a normal stage or danger stage. What shud I eat for my daily diet.

Hello Dr our new born baby girl second girl 1st no issues with Jandice and we are giving her breastmilk once in a while forumula she is only 10days old her billrubin test are the same staying at 16.4 around why its not dropping and we had her for about 6 days on a billiblanket if you plz can give us help should we start feeding forumla?

Kanaka N. Dear sir I’m suffering from jaundice from 20 days my bilirubin level 2.2 ,2.9,2.6′,2.4 mg / dl please advise how many day require to normal level I’m waiting for your replay

my bilirubin result is 1.9 mg/dl. is it normal ??

Sir,i am 23 yrs old.i want to know that my bilirubin point is 1.5mg/dl.is it normal ???

Just want to know there is a baby with 9 mg/dl bilirubin levels around 4.5 months age , suspected biliary atresia but the parents didnt went for cholangiogram neither surgery .
What could be the outcome ,
The child is otherwise perfectly fine , growing , gaining weight attaining 4 to 5 month milestones also , so what will be the outcome , theae levels of bilirubin will fall with time or the level 9 is not critical to think about

JAGDISH BALODI
Sir my wife 42 years old.. before 2-3 month ago she is suffering from jaundice.. as per report total bilirubin level 2.2, 2.1 what reason sir? Plz help me… is it dangerous? already use LIV-52 with normal diet.
From INDIA, NEW DELHI

Sir I am 21 years old.. before 8-9 month ago I am suffering from jundice.. my tottal billurubin level 2.8, 2.0,2.4 what reason sir? Plz help me… is it dangerous?

Is a newborn who just had light treatment for a jaundice level of 21.5 going to be ok or might there be effects?

im 33 years. bfore 1 month ago my bilirubil is 1.9.i treated and decrease 0.9.now i have 2.0.how can i treated it?

My name is Hadgu. from Africa, Ethiopia.
my child is 5 days old. she has some yellow color in her eye and i got a result of 1.15mg/dl in total and 0.6mg/dl in direct, what should i do?should i worry ?
would you advice me what to do?
thanks alot

Hi, Today i got my lever test report which showing my Bilirubin total 1.06 md/ dl.

Bilirubin (Conjuga) is 0.74 mg/dl
Bilirubin ( unconju is .0.32 mg/dl

is something.serious.I am 32 years old

My new born girl baby having Jaundice. Initial level is 14.6 and next check level is 14.9. What are causes, effects and remedies?

SIR MY GIRL CHILD 29 DAYS SUFFERING JAUNDICE HER BILLIRUBIN TOTAL 17.9 IN 4 DAYS THEN PHOTOTHERAPY START 5 DAYS BILL TOTAL 15.7 PHOTOTHERAPY STOPED THEN 22 DAYS BILL D 1.9 BILL TOTAL 19.8 TODAY BILL D 3.0 BILL TOTAL 16.9 WHAT OS THE DISEASE

At present my total bilirubin is 40mg/dl. Is this condition risky? If it is risky, what I will do now? Please tell me quickly.

My daughter’s 4-day old infant was just diagnosed with jaundice (21.6). The doctor told her it could lead to brain damage and that, even with treatment, her level will likely rise more before it starts to go down. She is breast feeding.

What is the normal level of billurobin of a newborn child of 4 days

Dear sir my son is 12 days old on the 4th day of his birth his bilirubin test was 4.6 and after treatment on the 11th day we test again and his bilirubin is 9.6 what do you suggest?please advice us for the improvement of his health I will be very thankful to you.

Sir, I’m in crpf training my total billirubin is 8.8 I am 21 year old

Please advice me

Is it risky???

Reply soon sir i m waiting

My wife is 32 years old. After 7 days fever with weakness and vomiting Her s.Bilirubin is 0.7. What is her condition ? Please, tell me.

Add your message here sir,l 23 year old my serum billrubin test is 0.9mg% hai l am helthy yes or no