Jaundice, also known as icterus, is the yellowish discoloration of the skin and eyes caused by the abnormal buildup of an orangish waste product called bilirubin. Bilirubin is produced by the normal breakdown of red blood cells (RBCs) and processed by the liver, where it is cleared from the body in bile. If too much bilirubin is produced or the liver cannot clear it, jaundice can develop.
Jaundice is not dangerous, but the underlying cause can be. Causes range from relatively benign conditions like Gilbert syndrome to potentially fatal ones like liver cancer. Jaundice can occur at any stage of life, including birth (neonatal jaundice). The treatment varies by the underlying cause.
This article describes the causes, symptoms, and diagnosis of jaundice in adults and children. It also explains how jaundice is treated and prevented, including when jaundice is a sign of a medical emergency.
Jaundice occurs when there is too much bilirubin in the body, referred to as hyperbilirubinemia. There are three main reasons why this might occur, which are:
The other classification of neonatal jaundice is an otherwise normal occurrence in newborns but one that can turn serious in some.
Red blood cells have a life span of around 120 days. They are broken down by the body and replaced by new ones. The process, called hemolysis, produces around 4 milligrams (mg) of unconjugated (free-circulating) bilirubin per day, which the liver usually disposes of in urine and stool.
Prehepatic jaundice is caused when hemolysis is increased, overwhelming the liver with more bilirubin than it can handle.
Possible causes of this include:
Once unconjugated bilirubin enters the liver, it is exposed to enzymes that transform it into conjugated bilirubin. This form can be incorporated into a digestive fluid called bile and eliminated from the body as it is carried away in the stool.
Hepatic jaundice is caused when liver cells involved in this process, called hepatocytes, are damaged. The damage may be transient (temporary) or permanent, caused by a wide range of infectious, autoimmune, inflammatory, and genetic diseases like:
Once bile leaves the liver, it is transported to the gallbladder for storage. Whenever food is eaten, it is released into the main duct, called the common duct, where it mixes with digestive fluids from the pancreas. These fluids are then released into the first part of the small intestine, called the duodenum, to break down fats and protein.
Posthepatic jaundice occurs when there is an obstruction in the pathway from the liver to the small intestine. This causes bile to back up into the liver, where bilirubin can escape.
Posthepatic jaundice may be due to an obstruction or a disease that causes bile ducts to become narrow or pinched. Examples include:
Neonatal jaundice is a common occurrence in newborns, affecting 60% of full-term babies and 80% of preterm babies. It usually develops by the second or third day of life and almost always clears on its own without consequence.
Neonatal jaundice is caused when fetal hemoglobin (the protein in red blood cells that carries oxygen) is broken down and replaced with the post-birth form of hemoglobin. This breakdown causes the release of more bilirubin than a newborn’s liver can clear.
On rare occasions, neonatal jaundice is not normal. Some of the same conditions that cause jaundice in adults—like G6PD deficiency, spherocytosis, and A1AT deficiency—can also affect newborns, leading to potentially life-threatening complications,
Other serious causes in newborns include:
Another relatively benign cause of jaundice is “breastfeeding jaundice,” a casual term for suboptimal intake jaundice. This usually occurs in the second week of life when a newborn is not getting enough nutrition.
Inadequate feeding delays the passage of the baby’s first poop (called the meconium), which contains large amounts of bilirubin. Breast milk is also thought to contain substances that can impair the conjugation of bilirubin in the liver.
Increased breastfeeding or supplementation with bottled formula will almost invariably help resolve the condition.
Jaundice is characterized by the yellowing of the skin and sclera (white of the eye) due to the buildup of bilirubin into tissues. Depending on the cause, the symptoms can be transient and barely noticeable or long-lasting and severe.
Jaundice symptoms can also differ in newborns.
On its own, jaundice does not cause anything other than yellowish discoloration. In many cases, it is the first sign of a disease and, in some, the only sign.
Jaundice in adults and children is typically pathologic, meaning it is related to a disease. If other symptoms accompany jaundice, it is due to the underlying disease. These symptoms can vary by whether the condition is hepatic, posthepatic, or prehepatic.
Hepatic and posthepatic causes of jaundice often manifest with symptoms of hepatitis (liver inflammation), causing:
Prehepatic jaundice caused by excessive hemolysis can lead to symptoms of hemolytic anemia, causing:
Neonatal jaundice is most often physiological, meaning it is related to normal bodily functions. Symptoms tend to develop within two to three days of birth, starting at the face and moving downward to the chest, stomach, legs, and feet.
Depending on the severity, there may be other symptoms such as excessive sleepiness, fussiness, and poor feeding, Over time, though, the yellowing will usually dissipate as large amounts of bilirubin are excreted in the baby’s stool and urine.
However, in some newborns, jaundice may be pathologic. This is typically the case when bilirubin levels are extremely high or when jaundice occurs immediately after birth or persists for weeks.
Persistent hyperbilirubinemia can lead to a potentially fatal condition called kernicterus, in which bilirubin invades the brain, causing brain dysfunction known as encephalopathy. If not treated immediately, kernicterus can lead to seizures, brain damage, and complications such as:
The duration of jaundice varies based largely on whether the underlying condition is acute (sudden and severe) or chronic (persistent or long-lasting). Generally speaking, the discoloration will fade once the underlying cause is resolved—whether it be an acute infection, biliary obstruction, or toxic drug reaction.
Jaundice has a typical course with some diseases (like acute viral hepatitis, which usually peaks in two weeks and starts to fade over two to three weeks). With other diseases, such as liver cancer, jaundice will only clear after a liver transplant.
With neonatal jaundice, the timeline is more consistent. In formula-fed babies, jaundice typically clears within two weeks. In breastfed babies, jaundice may last two to three weeks, sometimes longer.
While jaundice is usually self-evident, a physical exam and lab tests are needed to help narrow the possible causes.
As part of the evaluation, the healthcare provider will perform a urinalysis to check for bilirubin in your urine and liver function tests (LFTs) to measure levels of bilirubin and another byproduct called urobilinogen in your blood.
LFTs also measure liver enzymes called alkaline phosphatase (ALP), alanine transferase (ALT), and aspartate transferase (AST), which tend to rise with liver or biliary disease.
These results, paired with the color of your urine and stool, can help determine if the cause is prehepatic, hepatic, or posthepatic.
| Prehepatic | Hepatic | Posthepatic | |
|---|---|---|---|
| Total bilirubin | Normal or high | High | High |
| Unconjugated bilirubin | Normal | High | Normal |
| Conjugated bilirubin | Normal | High | High |
| Bilirubin in urine | Not present | Present | Present |
| Urine color | Normal | Dark | Dark |
| Stool color | Brown | Pale | Pale to white |
| ALT and AST | Normal | Very high | High |
| ALP | Normal | High | Very high |
| Urobilirubin | Normal to high | Low | Low to none |
Other tests and procedures may be ordered based on the initial findings, including imaging studies like ultrasound, computed tomography (CT), or magnetic resonance imaging (MRI) to check for blockages. A liver biopsy may also be performed to obtain a sample of liver tissue for evaluation in the lab.
Neonatal jaundice is monitored with blood tests that measure bilirubin in milligrams per deciliter of blood (mg/dL). Bilirubin can also be measured with a noninvasive, handheld device called a transcutaneous bilirubinometer, though blood testing remains the gold standard.
With physiological jaundice, newborns typically have unconjugated bilirubin levels between 12 and 15 mg/dL for the first two weeks, gradually decreasing to 2 mg/dL over the next month and eventually settling to a normal adult level of 0.2 to 0.8 mg/dL.
On the other hand, jaundice is considered pathologic if:
Jaundice is treated by resolving the underlying condition. The treatment varies by the cause.
Treatment may be provided by different specialists, such as:
If a bile duct is blocked, surgery or procedures like shock wave lithotripsy can help clear the obstruction. Surgery may also be needed for cancer of the liver, pancreas, gallbladder, or bile duct, along with chemotherapy and radiation.
When a chronic disease like cirrhosis or primary sclerosing cholangitis causes liver failure (meaning that the liver can no longer support the body’s needs), the only option may be a liver transplant.
In all other cases, the treatment is largely medical.
While most cases of jaundice in newborns resolve on their own, those with total bilirubins over 21 mg/dL should receive specialized phototherapy (sometimes referred to as “bili lights”).
Phototherapy involves exposure to a certain bandwidth of blue light (not ultraviolet light) that converts bilirubin in the skin into a water-soluble form that is more easily passed in urine. Home phototherapy machines allow home treatment outside of the hospital.
In severe cases, a procedure called an exchange transfusion can counteract the effects of kernicterus. Exchange transfusion is performed by slowly removing blood from the infant and replacing it with fresh donor blood or plasma. While potentially lifesaving, risks include blood clots, severe changes in blood chemistry, and shock.
Jaundice can’t always be prevented, but there are certain measures you can take to avoid some of the underlying causes, including:
Left untreated, the underlying causes of jaundice can turn serious and even life-threatening.
One of the key concerns is acute liver failure—also known as fulminant hepatic failure—which can sometimes develop rapidly in otherwise healthy individuals. This is especially true with severe drug-induced liver injury, in which a single event can cause irreparable damage requiring a liver transplant.
Autoimmune hepatitis and acute hepatitis A and B have also been known to cause acute liver failure.
Another concern is complications of hemolytic anemia, one of the most common causes of prehepatic jaundice. Severe cases have been known to cause life-threatening arrhythmia (irregular heartbeats), heart failure, and even death.
No amount of jaundice is considered “normal.” Call a healthcare provider immediately if you develop jaundice for any reason—even if it is mild and you have no other symptoms. Early intervention can help you avoid potentially serious complications.
Seek immediate emergency care if jaundice is accompanied by:
Call 911 or rush to the nearest emergency department if your baby has jaundice accompanied by signs of kernicterus, such as:
Jaundice is the yellowing of the skin and eyes caused by the abnormal buildup of bilirubin. Bilirubin is a byproduct of the breakdown of red blood cells.
Jaundice can be prehepatic (related to the excessive breakdown of red blood cells), hepatic (related to the liver), or posthepatic (related to the impaired flow of bile from the liver). Neonatal jaundice in newborns is usually normal but can become life-threatening if bilirubin levels are persistently high.
Jaundice is diagnosed with blood tests and will usually clear once the underlying condition is resolved. Infants with very high bilirubin levels may benefit from phototherapy or an exchange transfusion.
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