Watch newborn jaundice for these signals: yellow within 24 hours of birth, getting yellower, hard to wake or refusing feeds, pale stools — go to hospital the same day

13. Watch newborn jaundice for these signals: yellow within 24 hours of birth, getting yellower, hard to wake or refusing feeds, pale stools — go to hospital the same day

Cost: Registration plus bilirubin testing, within a few hundred yuan. Phototherapy if needed is usually about two days in hospital. The hard part is making the trip even when the baby still looks okay.

In plain terms: More than four in five newborns have some jaundice; most clear on their own. Yellow before 24 hours of age, or getting yellower, unusually sleepy and hard to rouse, refusing feeds, or floppy or stiff — go to hospital the same day. Pale or white stools may mean biliary atresia; get checked quickly. Very high bilirubin can injure the brain and cause lifelong disability.

Benefit: The American Academy of Pediatrics 2022 guideline states that “more than 80% of newborns will have some degree of jaundice.” High bilirubin can cause acute bilirubin encephalopathy and kernicterus. The guideline calls kernicterus “permanent crippling neurological disease,” with choreoathetoid cerebral palsy, upward gaze palsy, enamel dysplasia of primary teeth, and hearing loss. “Jaundice appearing within 24 hours after birth” is listed as a risk factor for severe hyperbilirubinemia. The UK NHS parent guidance has two tiers. Tier one: call emergency services or go to emergency — jaundice plus more sleepy than usual or hard to wake, not feeding, floppy or stiff, or seizures; jaundice before 24 hours of age also counts. Tier two: see a doctor urgently — after 24 hours, jaundice not improving or worsening, dark yellow or brown urine, or pale cream-colored stools. Globally, an estimated 480,000 newborns in 2010 had Rh hemolytic disease (ABO/Rh incompatibility) or extreme hyperbilirubinemia; 24% died and 13% developed kernicterus. Among survivors of kernicterus, more than 83% had one or more lasting impairments. Pale stools may indicate biliary atresia; Kasai procedure before 60 days of age greatly improves prognosis. Since 2004 Taiwan printed stool color cards in every newborn health handbook; surgery within 60 days rose from 60% in 2004 to 74.3% in 2005. After the cards, mortality in biliary atresia fell from 26.2% to 15.9% in a Taiwan population study — before-after, not a randomized trial.

Evidence grade: B

Sources: Kemper AR, Newman TB, Slaughter JL, et al. (2022). Clinical Practice Guideline Revision: Management of Hyperbilirubinemia in the Newborn Infant 35 or More Weeks of Gestation. Pediatrics, 150(3), e2022058859. <https://doi.org/10.1542/peds.2022-058859>; NHS. Jaundice in babies (reviewed 2026-03-24). <https://www.nhs.uk/conditions/jaundice-newborn/>; NICE (revised 2010, 2023). Jaundice in newborn babies under 28 days (CG98), 1.2.6, 1.7.1. <https://www.nice.org.uk/guidance/cg98/chapter/Recommendations>; Bhutani VK, Zipursky A, Blencowe H, et al. (2013). Neonatal hyperbilirubinemia and Rhesus disease of the newborn: incidence and impairment estimates for 2010 at regional and global levels. Pediatric Research, 74(Suppl 1), 86-100. <https://doi.org/10.1038/pr.2013.208>; Hsiao CH, Chang MH, Chen HL, et al. (2008). Universal screening for biliary atresia using an infant stool color card in Taiwan. Hepatology, 47(4), 1233-1240. <https://doi.org/10.1002/hep.22182>; 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. <https://doi.org/10.1097/MD.0000000000003166>; National Health and Family Planning Commission (2017). National basic public health service specifications (third edition), health management service specifications for children aged 0 to 6 years old. <https://www.nhc.gov.cn/ewebeditor/uploadfile/2017/04/20170417104506514.pdf>

Notes: Phototherapy uses special light on the skin to change bilirubin into forms that are easier to excrete. Do not substitute sunbathing at home: the AAP says sun exposure is hard to make both safe and effective, so it is not recommended as treatment. Do not give water or glucose water to “flush” jaundice — the guideline also advises against that. Visual yellow depth does not reliably estimate bilirubin level. UK NICE says not to rely on eyes alone; if unsure, measure once. Babies born before 38 weeks, siblings who had phototherapy, or insufficient breastfeeding raise risk of severe jaundice. Follow-up per the national basic public health service norm: home visit within one week after discharge; community health center or township clinic at 28–30 days — both visits check jaundice. If discharge orders include bilirubin recheck, go on that schedule. Full-term jaundice beyond 14 days or preterm beyond 21 days: NICE requires conjugated bilirubin testing and checking stool color. Jaundice alone does not delay vaccines (this section item 3). Newborn screening: Section 27, item 13 (heel-prick screening).