Quick answer. Newborn jaundice, a yellowing of the skin and eyes from a build-up of bilirubin, affects over half of all babies because their liver is still immature. Normal (physiological) jaundice appears on day 2 to 4, peaks around day 4 to 6 and fades by about two weeks. It is treated with phototherapy (blue light) if levels are high. In Singapore, all newborns are screened for G6PD deficiency, which can cause severe jaundice. Seek urgent medical review if jaundice appears in the first 24 hours, spreads to the legs, palms or soles, your baby feeds poorly or is very sleepy, has pale stools and dark urine, or jaundice lasts beyond two weeks.
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Jaundice is the yellow colouring of a baby’s skin and the whites of the eyes caused by a build-up of bilirubin, a substance made when red blood cells break down. It is extremely common, affecting more than half of all newborns, because a newborn’s liver needs a few days to mature before it can clear bilirubin efficiently. In most babies the jaundice is mild and harmless and settles on its own or with a short course of light treatment.
However, jaundice can occasionally signal a more serious problem, and very high untreated levels can harm the brain. This guide explains why jaundice happens, how to tell normal from worrying jaundice, what phototherapy involves, the role of G6PD deficiency (screened in every Singapore newborn), and the warning signs that mean your baby needs to be seen quickly.
At a glance
| Feature | Physiological (usually normal) | Pathological (needs urgent review) |
|---|---|---|
| When it appears | Day 2 to 4 of life | Within the first 24 hours of life |
| How it behaves | Peaks day 4 to 6, fades by about 2 weeks | Rises fast or stays beyond 2 weeks (prolonged) |
| How far it spreads | Mainly face and chest | Spreads to legs, palms and soles |
| Baby's condition | Feeding and active as usual | Poor feeding, very sleepy, high-pitched cry, fever |
| Action | Routine checks and follow-up | See a doctor promptly for bilirubin testing |
Why newborn jaundice is so common
Before birth, babies have extra red blood cells. After birth these are broken down, releasing bilirubin, an orange-yellow pigment. Bilirubin is normally processed by the liver and passed out in the stool. A newborn’s liver is still immature and takes a few days to do this efficiently, so bilirubin builds up and tints the skin and eyes yellow. This is why more than half of all newborns develop some jaundice in the first days of life, usually harmlessly.
Normal versus worrying jaundice
Most jaundice is physiological (normal): it appears around day 2 to 4, peaks at day 4 to 6, and clears by about two weeks. The yellow colour typically starts on the face and spreads downward; reaching the palms and soles suggests higher levels.
Pathological (abnormal) jaundice needs prompt attention. It may appear in the first 24 hours of life, rise very quickly, or last beyond two weeks. Causes include blood group (ABO or Rh) incompatibility, G6PD deficiency, infection, prematurity, or a liver or bile-duct problem. Pale, chalky stools with dark urine can point to a liver condition such as biliary atresia and must be checked urgently.
G6PD deficiency and Singapore newborn screening
G6PD deficiency is an inherited enzyme condition that makes red blood cells break down more easily, which can cause severe jaundice. It is relatively common in Singapore and more frequent in boys. Because of this, every baby born in Singapore is screened for G6PD deficiency, usually by testing umbilical cord blood at birth as part of the national newborn screening programme.
Babies with G6PD deficiency are watched closely for jaundice, often for the first few days. Parents are advised to avoid known triggers: naphthalene mothballs, fava (broad) beans, and certain medicines (such as some sulpha drugs and antimalarials). Always check any medicine or herbal supplement with a doctor or pharmacist first.
How jaundice is checked and treated
Jaundice is monitored during the hospital stay. Bilirubin can be estimated through the skin with a transcutaneous meter and confirmed with a serum bilirubin (SBR) blood test taken by heel prick.
If levels are high, the main treatment is phototherapy: the baby is placed (with eyes protected) under a special blue light that breaks down bilirubin so it can be removed from the body. This usually lasts a few days. For very severe or rapidly rising levels that do not respond, an exchange transfusion may be needed to quickly lower bilirubin and protect the brain. Thanks to routine checking and treatment, serious complications are now rare in Singapore.
Kernicterus: why high bilirubin matters
If bilirubin rises to very high levels and is left untreated, it can cross into the brain and cause kernicterus – permanent brain damage that may lead to cerebral palsy, hearing loss or developmental problems. This is why jaundice is checked so carefully and treated early. With Singapore’s routine monitoring, screening and phototherapy, kernicterus has become extremely uncommon – but it is the reason warning signs should never be ignored.
When to seek help and follow-up
Bring your baby to a doctor promptly if:
- Jaundice appears in the first 24 hours of life.
- The yellow colour spreads to the legs, palms or soles, or looks deeper.
- Your baby is feeding poorly, very sleepy, floppy, has a high-pitched cry or a fever.
- There are pale, chalky stools and dark urine.
- Jaundice lasts beyond two weeks.
After discharge, take your baby for the advised jaundice check around day 4 to 5, available at the birth hospital or a polyclinic. Breastfeeding jaundice (from not enough milk in the first week) is helped by improving feeding, while harmless breast milk jaundice can linger for several weeks once serious causes are excluded.
Related guides
- Best Paediatric Clinics in Singapore — our editorial shortlist
- paediatric clinics directory
- Childhood asthma
- Bedwetting in children
- Childhood obesity
Sources
- KKH – Neonatal Jaundice
- NUH – Jaundice (Newborn)
- NUH – G6PD Deficiency
- SingHealth – Neonatal Jaundice
- HealthHub – Guide to Common Infant Conditions
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