Watch these newborn jaundice signals: yellow within 24 hours of birth, or cannot be woken and will not feed, go to the hospital that day; getting yellower, or pale stools, go and get it checked soon

More than 8 in 10 newborns are a bit yellow. Yellow before 24 hours of age, or yellow together with being sleepier than usual and hard to wake, not feeding, or a body that is floppy or stiff, means go to the hospital immediately. After 24 hours, getting yellower, or stool that turns pale, also means get it checked soon. Pale stool can be biliary atresia (胆道闭锁). Bilirubin that is too high can injure the brain and leave a disability for life.

Cost

Registration plus a bilirubin test, within a few hundred yuan. If phototherapy is needed, it is usually about 2 days in hospital. The hard part is making the trip even when the child still looks all right.

Benefit

The American Academy of Pediatrics 2022 guideline says "more than 80% of newborns will have some degree of jaundice." Bilirubin that is too high can cause acute bilirubin encephalopathy and kernicterus (核黄疸). The guideline calls kernicterus "a permanent disabling neurological disease." Its features include cerebral palsy with limbs that twist on their own, an inability to look upward, poor enamel on the baby teeth, and hearing damage. The guideline lists "jaundice within 24 hours after birth" as a risk factor for going on to severe jaundice. The UK National Health Service (NHS) splits what it tells parents into 2 tiers. Tier 1 is to call emergency services or go straight to emergency care. That tier is a child who has jaundice and, at the same time, is sleepier than usual or hard to wake, is not feeding, is floppy or stiff, or has jerking movements. A child who is jaundiced before 24 hours of age is also in this tier. Tier 2 is to see a doctor as soon as possible. That tier is age past 24 hours, jaundice that is not getting better or is getting worse, urine that is dark yellow or brown, or stool that is pale cream. A global estimate is that in 2010 about 480000 newborns had Rh hemolytic disease (caused by a blood-type mismatch between mother and child) or extreme hyperbilirubinemia. Of those children, 24% died, and 13% developed kernicterus. Of the children who survived kernicterus, more than 83% were left with 1 or more impairments. Pale stool can be biliary atresia. That disease needs a Kasai operation (葛西手术) within 60 days before the result is clearly better. From 2004, Taiwan printed a stool color card in every newborn's child-health handbook. The share who had the operation within 60 days rose from 60% in 2004 to 74.3% in 2005. In another Taiwan-wide study, after the color card was introduced, mortality among children with biliary atresia fell from 26.2% to 15.9%. That is a before-and-after comparison, not a trial that split children into groups.

Notes

Phototherapy (light treatment) uses a special light on the child's skin so bilirubin changes into a form that is easier to pass. Do not replace it by sitting the child in the sun at home. The American Academy of Pediatrics says sunshine is hard to make both safe and free of sunburn, so it does not recommend it as treatment. Do not feed water or glucose water to bring the yellow down. That guideline also says not to. Looking at how yellow the skin is does not estimate how high the bilirubin is. The UK NICE guideline states that you should not rely on the eye alone. If you are not sure, go and measure it 1 time. A child born before 38 weeks, a child whose older sibling had phototherapy, or a child who has not had enough breast milk is more likely to turn severely yellow. Follow-up follows the national basic public-health service specification: within 1 week after discharge, a health worker visits the home. At 28 to 30 days after birth, go to a community health service center or a township hospital for a follow-up visit. Both of the 2 visits check jaundice. If the doctor arranged a bilirubin recheck at discharge, go at the time that was set. If a full-term child is still yellow after 14 days, or a preterm child after 21 days, the NICE guideline requires 1 check of conjugated bilirubin, and a look at whether the stool is pale. Jaundice itself does not delay vaccination. See item 3 of this section (vaccines). Newborn screening is in Section 27, item 13 (heel-prick screening).

Sources · 7

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2. NHS. Jaundice in babies（2026-03-24 审阅）. nhs.uk/conditions/jaundice-newborn/
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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. doi.org/10.1097/MD.0000000000003166
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