Why do a newborn’s sclera appear slightly yellow?

In daily life, we sometimes notice that a newborn’s sclera (the “white” of the eye) appears slightly yellow, which can cause significant psychological stress and concern about the child’s future development. So, what causes yellowing of the sclera in newborns?

What Causes Scleral Yellowing in Newborns?

Mild scleral yellowing in newborns is primarily attributable to the following causes. First, it may result from neonatal hepatitis—specifically, infection with cytomegalovirus (CMV) or hepatitis B virus (HBV). These viruses impair hepatic function, leading to hepatitis and subsequent scleral icterus (yellowing). Management involves antiviral therapy alongside hepatoprotective measures for the newborn.

Second, scleral yellowing may occur in newborns with jaundice—particularly hemolytic jaundice or jaundice secondary to biliary atresia. In such cases, both the sclera and skin appear markedly yellow. Treatment typically includes phototherapy (blue light irradiation) and, when indicated, exchange transfusion. Once serum bilirubin levels decline, the yellow discoloration of the sclera resolves.

Additionally, prompt treatment is critical: without timely intervention, affected infants are at risk for serious sequelae—including sensorineural hearing loss and neurodevelopmental impairment (e.g., intellectual disability). Therefore, if scleral yellowing is observed, parents should seek immediate medical evaluation and follow evidence-based management guided by a qualified healthcare provider. We hope this information is helpful!