Reasons for slow resolution of neonatal jaundice

Written by Shi Ji Peng
Pediatrics
Updated on May 29, 2025
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Newborns may experience physiological jaundice after birth, but due to various reasons, the jaundice may fade slower. Common causes include physiological dehydration, insufficient feeding, inadequate breast milk, or the baby having fewer and less smooth bowel movements, which can lead to physiological jaundice that also fades slowly. However, for physiological jaundice, it generally does not last more than four weeks in preterm infants and no more than two weeks in full-term infants. If the newborn's jaundice persists longer and fades slowly, pathological causes should be considered, such as whether it is due to hemolytic disease, neonatal infection, infant hepatitis, or biliary atresia.

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Is a bilirubin level of 20 high for a newborn?

If a newborn's skin jaundice reaches a level of twenty, it is a warning sign that the jaundice is significantly elevated. It is advised to promptly go to the hospital for an examination. If the bilirubin levels in the blood are indeed that high, timely intervention and treatment are necessary. Normally, for physiological jaundice, the levels should not exceed fifteen after seventy-two hours in infants. Even during the peak period of four to five days, it should not surpass fifteen. If the jaundice noticeably increases within the first three days and exceeds twenty, the severity of the jaundice might be worse. The younger the newborn, especially with levels above twenty, the higher the risk of bilirubin entering the brain, potentially leading to bilirubin encephalopathy. Therefore, with jaundice reaching twenty, it is still recommended to promptly go to the hospital for intervention and treatment.

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What causes jaundice in newborns?

Neonatal jaundice is primarily due to the overproduction of bilirubin, which means a higher number of red blood cells are being destroyed, leading to an increased concentration of bilirubin in the blood. Additionally, there is a metabolic disorder of bilirubin in the child. The liver cells' ability to take up and bind bilirubin decreases, which can cause an increase in the concentration of unbound bilirubin in the serum, resulting in jaundice. This mainly occurs in cases of hypoxia, infection, and some congenital diseases, among others. Certain medications and reduced thyroid function can also present this symptom. The third issue is an impairment in the bile's ability to excrete bilirubin, which can occur when the child has neonatal hepatitis or congenital metabolic defects, leading to jaundice.

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Symptoms of higher neonatal jaundice

Neonatal jaundice is one of the common symptoms during the neonatal period, with about 80% of full-term infants visibly exhibiting jaundice. Jaundice may occur as part of the normal developmental process or as a manifestation of certain diseases. It is categorized into physiological jaundice and pathological jaundice. High levels of jaundice may indicate pathological jaundice. Generally, if the baby's skin and mucous membranes are obviously yellow, and the jaundice has spread to the limbs or even beyond the palms and soles, which are also notably yellow, it is a sign that the jaundice is severe. Parents can typically observe a clear yellowing of the sclera, the white part of the eyes. The baby may also show other signs of discomfort, such as significant crying and restlessness, pronounced vomiting or increased regurgitation, or even symptoms like abdominal bloating, diarrhea, reluctance to feed, prolonged feeding times, lethargy, or potentially even fever and other discomforts.

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normal values of neonatal jaundice

Neonatal jaundice is the most common phenomenon in the neonatal period, generally divided into physiological jaundice and pathological jaundice. If the baby's values are within the normal range, it may be physiological jaundice, which does not require special intervention and will resolve on its own. Typically, normal physiological jaundice appears 2-3 days after birth, peaks around 4-5 days, begins to lessen about a week later, and resolves within two weeks, generally occurring in full-term infants born after 37 weeks. It's advisable for babies to have their jaundice monitored daily within the first two weeks, especially during the peak period, from 2-3 days to about a week or around ten days, when jaundice monitoring should be more frequent. Normally, it's best if the bilirubin levels in newborns do not exceed 6 mg/dL in the first 24 hours, 9 mg/dL within 24-48 hours, 12 mg/dL within 48-72 hours, and 15 mg/dL after 72 hours. These values are generally considered acceptable. Additionally, jaundice progression should not be too rapid; if bilirubin levels rise more than 5 mg/dL within 24 hours, it indicates too rapid an increase in jaundice. In such cases, it is also necessary to go to the hospital, where a neonatal doctor should assess the baby and decide if special treatment intervention is needed.

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Is neonatal jaundice pneumonia serious?

Neonatal jaundice is one of the common symptoms in the newborn period, especially in early newborns. It can be a symptom of the normal developmental process in newborns or a manifestation of certain diseases. If a newborn has jaundice combined with pneumonia, it is possible that the pneumonia is infectious, and infection is also one of the common causes of jaundice. Therefore, if the inflammation is not controlled, it may repeatedly rebound or continue to rise. If the symptoms of pneumonia are not very severe and the baby is generally in good condition with not particularly high infection indicators, general anti-infective treatment for pneumonia along with corresponding treatment to reduce jaundice will generally have no lasting impact on the baby, as long as it is cured. However, if it is a severe case of pneumonia and the situation is not particularly good, and the jaundice remains very high and severe, it might have a slight impact on the baby later on. If bilirubin encephalopathy occurs, the possibility of neurological sequelae may be greater. Generally, ordinary pneumonia combined with jaundice does not have much impact on the baby.