👶 Men's Health

Neonatal Jaundice (Nigeria Guide)

Yellow skin in newborns — when it is normal, when it is dangerous, and how to treat it

Neonatal jaundice — yellowing of a newborn's skin and eyes — is very common, affecting up to 60% of full-term and 80% of preterm newborns. Most jaundice in newborns is physiological (normal) and resolves without treatment. However, severe jaundice from haemolytic disease (blood group incompatibility) or infection can cause kernicterus — permanent brain damage — and is a leading preventable cause of disability in Nigeria. Recognising the warning signs and accessing phototherapy promptly saves lives and prevents disability.

Signs and Symptoms

✓ Yellow colouration of the skin and white of the eyes (sclera), starting on the face

✓ Spreading downward to the chest, abdomen, and legs — the more the spreading, the higher the bilirubin

✓ Physiological jaundice: appears on day 2–3, peaks day 4–5, resolves by day 10–14

✓ DANGEROUS SIGNS — seek immediate help: jaundice in first 24 hours of life, high-pitched cry, arching of the back, seizures, extreme sleepiness, refusal to feed, fever

Risk Factors

Prematurity — immature liver less able to process bilirubin
ABO incompatibility — mother O, baby A or B (most common cause of haemolytic jaundice in Nigeria)
Rhesus incompatibility — Rh-negative mother, Rh-positive baby
G6PD deficiency — very common in Nigeria (10–15% of males); haemolysis triggered by infections, drugs, or naphthalene (mothballs)
Infection (sepsis) — any neonatal infection worsens jaundice
Exclusive breastfeeding — breastfeeding jaundice peaks day 3–5 (lack of milk triggering); breast milk jaundice prolonged (up to 6 weeks) — both are benign
Bruising from a difficult delivery — breakdown of haematoma produces bilirubin
Polycythaemia (high red blood cell count) — from delayed cord clamping or twin-to-twin transfusion

When to Seek Help

EmergencyANY jaundice in the first 24 hours of life — haemolytic disease, requires same-day assessment and possible exchange transfusion

Same dayJaundice spreading below the navel, or baby with high-pitched cry, extreme sleepiness, seizures, or arching — severe hyperbilirubinaemia or kernicterus

Same dayJaundice in a premature baby — lower bilirubin thresholds for intervention

Within 24 hoursJaundice in any newborn with poor feeding, fever, or appearing unwell — infection must be excluded

RoutineYellow baby at home who is feeding well and alert — take to the nearest primary health centre for bilirubin check or transcutaneous bilirubinometry

Tests & Diagnosis

🧪 Transcutaneous bilirubinometry (TCB)

Non-invasive skin measurement — available at many Nigerian PHCs as a screening tool. Does not replace blood measurement for high readings

🧪 Total serum bilirubin (TSB)

Gold standard — venous or capillary blood sample. Plotted on a nomogram (Bhutani hour-specific bilirubin chart) to determine risk and need for phototherapy

🧪 Blood group and Coombs test (DAT)

Mother's and baby's blood group — for ABO/Rh compatibility. Direct Coombs test on baby's blood confirms haemolytic disease

🧪 G6PD assay

For haemolytic jaundice without ABO/Rh incompatibility — G6PD deficiency is the most common enzyme deficiency causing haemolytic disease in Nigerian newborns

🧪 FBC and peripheral smear

Anaemia in haemolysis. Spherocytes in ABO incompatibility

🧪 Blood culture and sepsis screen

If fever, poor feeding, or early-onset jaundice suggests infection

Treatment Options

Phototherapy — the primary treatment

Blue-spectrum light breaks down bilirubin in the skin. Requires continuous exposure — the baby is kept under the phototherapy lamp (or blanket) with eyes covered. Feed frequently to promote bilirubin excretion. Available at all secondary and tertiary hospitals in Nigeria. LED phototherapy is most effective — becoming more available in Nigeria through UNICEF and NGO support

Increase breastfeeding frequency

In breastfeeding jaundice — 8–12 feeds per 24 hours helps clear bilirubin through the stool. Do NOT stop breastfeeding for jaundice — breastfeeding cessation is rarely needed and is harmful to bonding and nutrition

Exchange transfusion

For very high bilirubin levels not responding to phototherapy, or any signs of kernicterus. The baby's blood is progressively replaced with donor blood — removes sensitised red cells and bilirubin. Life-saving but requires skilled neonatal team and compatible blood. Available at tertiary neonatal units

Intravenous immunoglobulin (IVIG)

For severe haemolytic disease (Rh or ABO incompatibility) — reduces haemolysis and may prevent exchange transfusion. Available at LUTH, UCH, and some well-equipped private NICUs

Avoid G6PD triggers in the newborn period

Do NOT use naphthalene (camphor/mothballs) in baby's bedding or clothing — a frequent cause of haemolysis in G6PD-deficient Nigerian newborns. Avoid menthol oils, fava beans (broad beans), and certain antibiotics (nitrofurantoin) in G6PD-deficient infants

Prevention of Rh incompatibility

Anti-D immunoglobulin given to Rh-negative mothers at 28 weeks and after delivery — prevents sensitisation. Anti-D must be given within 72 hours of delivery. Blood group testing at first antenatal visit is essential for all pregnant women

Frequently Asked Questions

Should I put my jaundiced newborn in sunlight?

Indirect, filtered sunlight has some phototherapy effect. However, direct sunlight in Nigeria is intense and carries risks of hyperthermia (overheating), dehydration, and sunburn in a newborn. It is NOT a substitute for medical phototherapy for significant jaundice. If a hospital or PHC with a phototherapy lamp is available, use it. Brief, supervised window-filtered indirect sunlight (not peak sun hours) may be used as a supplement, not replacement.

How long does jaundice last in newborns?

Physiological (normal) jaundice: appears day 2–3, peaks day 4–5, resolves by day 10–14 in full-term babies and up to 3 weeks in premature babies. Breast milk jaundice can persist up to 6 weeks — this is benign. Any jaundice persisting beyond 2 weeks in a formula-fed baby or 3 weeks in a breastfed baby needs investigation to exclude biliary atresia or other pathology.

Can jaundice cause brain damage?

Yes — severe, untreated jaundice (very high bilirubin) causes kernicterus — permanent brain damage affecting movement, hearing, and vision. Kernicterus is a leading cause of childhood disability in Nigeria and is preventable with timely phototherapy. The warning signs of bilirubin approaching dangerous levels: extreme sleepiness, high-pitched cry, arching of the back (opisthotonus), refusal to feed. These require EMERGENCY assessment.

Is G6PD deficiency common in Nigerian babies?

Yes — G6PD deficiency affects 10–15% of Nigerian males and 1–4% of females. It is the most common enzyme deficiency causing neonatal haemolytic jaundice in Nigeria. All Nigerian newborns should ideally be screened (or parents informed of the risk). The key message for families of G6PD-deficient children: avoid naphthalene mothballs in bedding, avoid certain medications (check with your doctor), and know that infections can trigger haemolysis.