Summary
Definition
History and exam
Key diagnostic factors
- presence of risk factors
- cephalocaudal progression
- decreasing gestational age
- male
- family history of jaundice
- family history of anemia
- family history 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
- Asian
- American-Indian
- maternal diabetes
- oxytocin in labor
- low birth weight
- decreased gestational age
- decreased caloric intake and weight loss
- breast-feeding
- delayed cord clamping (2 to 3 minutes)
- genetic factors
Diagnostic tests
1st tests to order
- transcutaneous bilirubin (TcB)
- total serum bilirubin
- direct Coombs test
- direct serum bilirubin
Tests to consider
- hematocrit
- CBC
- reticulocyte count
- peripheral blood smear
- blood groups
- glucose-6-phosphate dehydrogenase (G6PD) 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
physiologic hyperbilirubinemia
pathologic hyperbilirubinemia: unconjugated
pathologic hyperbilirubinemia: conjugated
breast-feeding/breast milk jaundice
Contributors
Authors
Vineet Bhandari, MBBS, MD, DM
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
Camden
NJ
Disclosures
VB declares that he has no competing interests.
Peer reviewers
Rima Fawaz, MD
Associate Professor of Pediatrics
Medical Director, Pediatric Hepatology and Pediatric Liver Transplantation
Yale University School of Medicine
New Haven
CT
Disclosures
RF declares that she has no competing interests.
Alex Kemper, MD, MPH, MS
Professor of Pediatrics
Division Chief of Primary Care Pediatrics
Nationwide Children's Hospital
Columbus
OH
Disclosures
AK declares that he has no competing interests.
Helen McElroy, MBChB, MRCPI, MSc
Consultant Neonatologist
Neonatology
Medway Maritime Hospital
Gillingham
UK
Disclosures
HM declares that she has no competing interests.
References
Key articles
Kemper AR, Newman TB, Slaughter JL, et al. Clinical practice guideline revision: management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation. Pediatrics. 2022 Sep 1;150(3):e2022058859.Full text
Woodgate P, Jardine LA. Neonatal jaundice: phototherapy. BMJ Clin Evid. 2015 May 22;2015:. Abstract
Slaughter JL, Kemper AR, Newman TB. Technical report: Diagnosis and management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation. Pediatrics. 2022 Sep 1;150(3):e2022058865.Full text Abstract
Gu J, Zhu Y, Zhao J. The efficacy of intravenous fluid supplementation for neonatal hyperbilirubinemia: a meta-analysis of randomized controlled studies. J Matern Fetal Neonatal Med. 2019 Nov 17;1-6. Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Guidelines
- Clinical practice guideline revision: Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation
- Technical report: Diagnosis and management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation
More GuidelinesPatient information
Jaundice in newborn babies: what is it?
Jaundice in newborn babies: what treatments work?
More Patient information
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