Last reviewed: November 2017
Last updated: March  2017

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • cephalocaudal progression
  • decreasing gestational age
  • male
  • FHx of jaundice
  • FHx of anemia
  • FHx of splenectomy
  • maternal exposure to sulfonamides or antimalarials
  • hepatosplenomegaly
  • microcephaly
  • chorioretinitis
  • small for gestational age
  • cephalhematoma
  • hypertonia
  • high-pitched cry
  • retrocollis
  • opisthotonus

Other diagnostic factors

  • perinatal asphyxia
  • macrosomia
  • plethora
  • hypotonia
  • lethargy

Risk factors

  • East Asian
  • native American
  • maternal diabetes
  • oxytocin in labor
  • low birth weight
  • decreased gestational age
  • decreased caloric intake and weight loss
  • breastfeeding
  • delayed cord clamping (2 to 3 minutes)

Diagnostic investigations

1st investigations to order

  • transcutaneous bilirubinometer
  • total serum bilirubin
  • direct Coombs test
  • direct serum bilirubin
  • Hct
  • CBC
  • reticulocyte count
  • peripheral blood smear
  • blood groups
Full details

Investigations to consider

  • G6PD screening
  • osmotic fragility test
  • blood culture
  • LFTs
  • urine for reducing substances
  • plasma amino acids
  • urine organic acids
  • urine culture
  • abdominal ultrasound
  • percutaneous liver biopsy
Full details

Treatment algorithm

Contributors

Authors VIEW ALL

Vineet Bhandari

Professor of Pediatrics Obstetrics and Gynecology

Drexel University College of Medicine

Chief, Section of Neonatal Medicine

St. Christopher's Hospital for Children/Hahnemann University Hospital/Temple University Hospital

Philadelphia

PA

Disclosures

VB declares that he has no competing interests.

Peer reviewers VIEW ALL

Professor of Pediatrics

Baylor College of Medicine

Section Head and Service Chief of Neonatology

Texas Children's Hospital

Houston

TX

Disclosures

GKS declares that he has no competing interests.

Consultant Neonatologist

Neonatology

Medway Maritime Hospital

Gillingham

UK

Disclosures

HM declares that she has no competing interests.

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