Last reviewed: 23 Dec 2021
Last updated: 10 Aug 2021



History and exam

Key diagnostic factors

  • presence of risk factors
  • cephalocaudal progression
  • decreasing gestational age
  • male
  • family history of jaundice
  • family history of anaemia
  • family history of splenectomy
  • maternal exposure to sulphonamides or antimalarials
  • hepatosplenomegaly
  • microcephaly
  • chorioretinitis
  • small for gestational age
  • cephalhaematoma
  • hypertonia
  • high-pitched cry
  • retrocollis
  • opisthotonus

Other diagnostic factors

  • perinatal asphyxia
  • macrosomia
  • plethora
  • hypotonia
  • lethargy

Risk factors

  • Asian
  • American-Indian
  • maternal diabetes
  • oxytocin in labour
  • low birth weight
  • decreased gestational age
  • decreased caloric intake and weight loss
  • breastfeeding
  • delayed cord clamping (2-3 minutes)
  • genetic factors

Diagnostic investigations

1st investigations to order

  • transcutaneous bilirubinometer
  • total serum bilirubin
  • direct Coombs' test
  • direct serum bilirubin
  • haematocrit
  • FBC
  • 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

Treatment algorithm



Vineet Bhandari, MBBS, MD, DM
Vineet Bhandari

Division Head, Neonatology

Department of Pediatrics

The Children’s Regional Hospital at Cooper

Professor of Pediatrics

Cooper Medical School of Rowan University

Camden, NJ


VB declares that he has no competing interests.

Peer reviewers

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

Consultant Neonatologist


Medway Maritime Hospital




HM declares that she has no competing interests.

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