Neonatal jaundice

Last reviewed: 4 Jan 2023
Last updated: 10 Aug 2022



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
More key diagnostic factors

Other diagnostic factors

  • perinatal asphyxia
  • macrosomia
  • plethora
  • hypotonia
  • lethargy
Other diagnostic factors

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
More risk 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
More 1st investigations to order

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
More investigations to consider

Treatment algorithm


physiological hyperbilirubinaemia

pathological hyperbilirubinaemia: unconjugated

pathological hyperbilirubinaemia: conjugated

breast milk jaundice



Vineet Bhandari, MBBS, MD, DM
Vineet Bhandari

Division Head, Neonatology

Vice Chair, Faculty Development

Department of Pediatrics

The Children's Regional Hospital at Cooper

Professor of Pediatrics, Obstetrics and Gynecology and Biomedical Sciences

Cooper Medical School of Rowan University




VB declares that he has no competing interests.

Peer reviewers

Gautham K. Suresh, MD, DM, MS

Professor of Pediatrics

Chair of Pediatrics and Pediatrician-in-Chief

Nemours 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.

  • Neonatal jaundice images
  • Differentials

    • Carotenaemia
    More Differentials
  • Guidelines

    • Postnatal care
    • Neonatal jaundice
    More Guidelines
  • Patient leaflets

    Jaundice in newborn babies: what is it?

    Jaundice in newborn babies: what treatments work?

    More Patient leaflets
  • padlock-lockedLog in or subscribe to access all of BMJ Best Practice

Use of this content is subject to our disclaimer