Newborn Jaundice Phototherapy (Neeli Light)
Newborn jaundice (peelia / yarqan) is one of the most common reasons babies are readmitted to hospital in the first week of life. In most babies it is mild and settles on its own. In some, bilirubin rises too high and the baby needs phototherapy (light treatment). This guide explains what phototherapy is, when it is truly needed, and what parents and grandparents should and should not do at home.
This is a treatment-focused article in our newborn health series. For the complete overview, read our main guide: Newborn Jaundice: When Is It Dangerous?
What causes jaundice in newborns?
Jaundice is yellow colouring of the skin and eyes caused by bilirubin, a yellow pigment made when red blood cells break down. Newborns make more bilirubin than adults, and the newborn liver is still learning to remove it. Common causes include:
- Physiological jaundice: the most common type. It appears after the first 24 hours, usually peaks on day 3 to 5, and fades within about 2 weeks.
- Breastfeeding jaundice: higher bilirubin because the baby is not getting enough milk in the first days.
- Breast milk jaundice: a harmless prolonged jaundice in a well, feeding, growing baby, usually after the first week.
- Blood group incompatibility: mother's blood group O or Rh-negative and baby's blood group different (ABO or Rh incompatibility).
- G6PD deficiency: an inherited enzyme deficiency that is not uncommon in Pakistan and can cause a sudden, sharp rise in bilirubin.
- Other causes: prematurity, infection, bruising or cephalhematoma, and liver or bile duct problems.
- Yellow colour appears within the first 24 hours of birth
- Yellowness spreads to the belly, legs, palms or soles
- Baby is very sleepy, hard to wake, feeding poorly or floppy
- High-pitched cry, arching of the back, fever or vomiting
- Pale (clay-coloured) stools or dark urine
- Jaundice lasts more than 2 weeks in a full-term baby
How do doctors check the bilirubin level?
Looking at the skin is not reliable, especially in babies with darker skin tones or when light is poor. Doctors use a transcutaneous bilirubinometer (a skin scanner) as a screening test, and a serum bilirubin (TSB) blood test to confirm. The result is plotted against the baby's age in hours, gestational age and risk factors to decide whether to observe, repeat the test, or start phototherapy. Your doctor may also check the baby's and mother's blood groups, a Coombs test, complete blood count and G6PD, depending on the situation.
What is phototherapy?
Phototherapy is treatment with a special blue-green light (about 460 to 490 nm). When this light falls on the baby's skin, it changes bilirubin into a form that can be passed out in urine and stool without needing the liver to process it first. It does not burn the skin and it does not contain harmful UV rays when done with proper medical equipment.
When is phototherapy necessary?
Phototherapy is started when the bilirubin level crosses the treatment threshold for that specific baby. The threshold is lower for:
- Premature babies and low birth weight babies
- Babies younger in hours of life
- Babies with risk factors such as blood group incompatibility, G6PD deficiency, infection or significant weight loss
Not every yellow baby needs phototherapy. Many babies with mild jaundice only need good feeding, monitoring and a repeat check. On the other hand, a baby can need urgent treatment even when parents think the yellow colour "is not that much." Always follow your paediatrician's advice.
What happens during phototherapy?
- The baby is placed undressed (only a diaper) under or on the light so that as much skin as possible is exposed.
- The eyes are covered with soft eye protection.
- Bilirubin is rechecked at intervals, usually every 4 to 24 hours depending on how high it was.
- Breastfeeding or formula feeding continues, often 8 to 12 times a day. Feeding helps the baby pass bilirubin in stool.
- Treatment stops when bilirubin falls well below the treatment line. A repeat test may be done 12 to 24 hours later to check for rebound.
Babies with very high bilirubin may need intensive phototherapy (stronger light on more skin surface) and, rarely, an exchange transfusion in a neonatal intensive care unit to prevent brain injury.
Are there side effects of phototherapy?
Phototherapy is generally safe. Possible short-term effects include loose green stools, mild rash, dehydration if feeding is poor, temperature changes, and fussiness. These are manageable and settle after treatment. Proper eye protection, temperature monitoring and feeding support prevent most problems.
Home care and common mistakes
- Feed the baby frequently, at least 8 to 12 times in 24 hours
- Keep follow-up appointments for repeat bilirubin checks
- Watch wet diapers, stool colour, alertness and feeding
- Take the baby to hospital quickly if any danger sign appears
- Do not stop breastfeeding because of jaundice
- Do not give ghutti, honey, sugar water, plain water or herbal syrups. They do not treat jaundice and can cause infection, dehydration or poor feeding.
- Do not rely on sunlight alone. It is not a dependable treatment, and it risks sunburn, overheating or chilling in a newborn.
- Do not use camphor, naphthalene (safaid goli) or mothballs near the baby's clothes or bedding, especially if G6PD deficiency is possible.
- Do not wait "one more day" if the baby looks worse. Jaundice can rise fast.
Can jaundice damage the brain?
Very high, untreated bilirubin can enter the brain and cause acute bilirubin encephalopathy and, if severe, permanent damage called kernicterus (hearing loss, movement problems, developmental delay). This is rare when jaundice is checked early and treated on time. That is exactly why phototherapy matters.
Key takeaways
- Most newborn jaundice is harmless, but some needs treatment.
- Jaundice in the first 24 hours is always an emergency.
- Phototherapy is safe and effective when the level crosses the treatment line.
- Keep feeding, avoid home remedies, and follow up with your doctor.
Disclaimer: This article is for general education and does not replace a doctor's examination. If your baby looks yellow, please see a paediatrician or go to the nearest hospital.