Newborn jaundice: visual assessment, bilirubin checks and phototherapy care
- Procedure
The nurse looks for jaundice every day, has it measured when seen, and cares for the baby under phototherapy without stopping breastfeeding.
What it is
Most newborns become a little yellow around days 2 to 4, and it usually fades within 2 weeks. Jaundice in the first 24 hours, or jaundice that is deep or rising fast, can mean disease and needs prompt measurement. Looking at the skin helps find jaundice but does not tell the level, so any visible jaundice is measured with a skin meter or a blood test. If the level is high for the baby's age in hours, the doctor orders phototherapy: light on the bare skin changes bilirubin so the body can remove it. The nurse prepares the baby, protects the eyes, keeps feeds going and watches temperature and hydration.
Indications
- Jaundice in the first 24 hours of life.
- Visible jaundice at any age, to measure the level.
- Bilirubin above the treatment line for the baby's age in hours, gestational age and risk factors, per the institutional chart.
- Higher risk: preterm babies, blood group incompatibility, bruising or scalp bleeding, infection, poor feeding.
Contraindications and precautions
- Never put the baby in the sun to treat jaundice.
- Keep breastfeeding during phototherapy; give feeds often.
- Keep the eyes covered while the light is on.
- Read bilirubin against the baby's age in hours, not days.
Equipment
- A phototherapy unit (lamp, blanket or light mattress) and eye shields.
- A thermometer and a scale.
- A skin bilirubin meter if available, or blood sampling material as ordered.
- A feeding and nappy chart.
Step by step (and why)
- Look at the undressed baby in good light, press the skin with a thumb and check from head to feet — blanching shows the yellow under the skin.
- Tell the doctor about any jaundice in the first 24 hours or jaundice that is spreading — these babies need an urgent level.
- Take or help take the skin or blood measurement as ordered, and note the baby's age in hours — the level is read against hours of life.
- For phototherapy, undress the baby to the nappy and put on the eye shields — more skin under the light works better and the eyes are protected.
- Keep the light on the skin and the baby in position — breaks in exposure reduce the effect.
- Support feeds 8 to 12 times a day and keep breaks for feeding short — feeding moves bilirubin out in the stools.
- Check temperature, count wet and dirty nappies and weigh daily — light can overheat or dry out the baby.
- Check that the eye shields stay in place and cover the eyes — protects the eyes from the light.
- Take the follow-up levels at the times ordered and record each one — the trend decides when to stop.
Complications
- Very high bilirubin can cause kernicterus, brain damage with deafness or cerebral palsy; early detection and treatment almost always prevent it.
- Overheating or cooling under the light.
- Dehydration and fewer wet nappies.
- Feeding problems from separating the baby from the mother.
Next step: when to call for help
- Jaundice in the first 24 hours, or yellow palms and soles: call at once.
- Jaundice with fever, sleepiness or poor feeding: urgent assessment.
- Pale stools, jaundice that keeps increasing, or jaundice that starts after day 7 or lasts beyond day 14: tell the doctor.
- A bilirubin level rising fast or near the exchange-transfusion line: tell the doctor at once.
Test yourself
Think of the answer, then tap the question to see it.
Why is a newborn with visible jaundice measured instead of judged by eye?
Because visual assessment is not reliable enough to estimate the bilirubin level or to rule out jaundice.
What does the nurse do to prepare a baby for phototherapy?
Undresses it to the nappy, covers the eyes with shields and places as much skin as possible under the light.
Why should breastfeeding continue during phototherapy?
Frequent feeds help remove bilirubin through the stools and prevent dehydration.
Why is sunlight not used to treat newborn jaundice?
It is not enough to treat significant jaundice and it can cause burns, irritation and dehydration.
Elsewhere in DurgiPedia
Connections
Educational content for students; it does not replace your institution's protocols, supervised clinical training or a prescriber's order. Dose-calculation examples use made-up numbers: they are educational, not a clinical order.
Sources: Newborn jaundice (MedlinePlus, U.S. National Library of Medicine, 2025); Reliability of visual assessment of neonatal jaundice among neonates of black descent: a cross-sectional study from Tanzania (BMC Pediatrics 2021) (Dionis I et al., via PubMed Central, 2021); Resolución 3280 de 2018: lineamientos técnicos y operativos de la Ruta de Promoción y Mantenimiento de la Salud y de la Ruta Materno Perinatal (Ministerio de Salud y Protección Social de Colombia, 2018); Guía de práctica clínica del recién nacido sano: para padres y cuidadores (Guía No. 02) (Ministerio de Salud y Protección Social de Colombia, Colciencias, 2013).
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