Neonatal jaundice is usually noted clinically when serum bilirubin is >85.5 micromol/L (5 mg/dL). Occurs in 50% to 70% of term neonates. Most cases are physiological.
Jaundice in the first 24 hours of life is considered pathological.
Treatment for severe hyperbilirubinaemia includes phototherapy and/or exchange transfusion.
The major complication of unconjugated hyperbilirubinaemia is kernicterus.
Neonatal jaundice is the yellowing discoloration of the skin and sclera of a neonate, which is caused by increased levels of bilirubin in the blood. A neonate refers to an infant in the first 28 days of life.
This topic focuses on recognising and managing early neonatal jaundice, which is most commonly caused by unconjugated hyperbilirubinaemia. While prolonged jaundice with conjugated hyperbilirubinaemia may present during this period, appropriate management depends on the pathological cause and detailed commentary is beyond the scope of this material.
History and exam
Key diagnostic factors
- presence of risk factors
- cephalocaudal progression
- decreasing gestational age
- family history of jaundice
- family history of anaemia
- family history of splenectomy
- maternal exposure to sulphonamides or antimalarials
- small for gestational age
- high-pitched cry
Other diagnostic factors
- perinatal asphyxia
- maternal diabetes
- oxytocin in labour
- low birth weight
- decreased gestational age
- decreased caloric intake and weight loss
- delayed cord clamping (2-3 minutes)
- genetic factors
1st investigations to order
- transcutaneous bilirubinometer
- total serum bilirubin
- direct Coombs' test
- direct serum bilirubin
- reticulocyte count
- peripheral blood smear
- blood groups
Investigations to consider
- glucose-6-phosphate dehydrogenase screening
- osmotic fragility test
- blood culture
- liver function tests
- urine for reducing substances
- plasma amino acids
- urine organic acids
- urine culture
- abdominal ultrasound
- percutaneous liver biopsy
pathological hyperbilirubinaemia: unconjugated
pathological hyperbilirubinaemia: conjugated
breast milk jaundice
Vineet Bhandari, MBBS, MD, DM
Division Head, Neonatology
Department of Pediatrics
The Children’s Regional Hospital at Cooper
Professor of Pediatrics
Cooper Medical School of Rowan University
VB declares that he has no competing interests.
Gautham K. Suresh, MD, DM, MS
Professor of Pediatrics
Baylor College of Medicine
Section Head and Service Chief of Neonatology
Texas Children's Hospital
GKS declares that he has no competing interests.
Helen McElroy, MBChB, MRCPI, MSc
Medway Maritime Hospital
HM declares that she has no competing interests.
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- Neonatal jaundice
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