Neonatal jaundice is usually noted clinically when serum bilirubin is >5 mg/dL. Occurs in 60% to 70% of term neonates. Most cases are physiologic.
Jaundice in the first 24 hours of life is considered pathologic.
Treatment for severe hyperbilirubinemia includes phototherapy and/or exchange transfusion.
The major complication of unconjugated hyperbilirubinemia 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 recognizing and managing early neonatal jaundice, which is most commonly caused by unconjugated hyperbilirubinemia. While prolonged jaundice with conjugated hyperbilirubinemia may present during this period, appropriate management depends on the pathologic 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 anemia
- family history of splenectomy
- maternal exposure to sulfonamides or antimalarials
- small for gestational age
- high-pitched cry
Other diagnostic factors
- perinatal asphyxia
- maternal diabetes
- oxytocin in labor
- low birth weight
- decreased gestational age
- decreased caloric intake and weight loss
- delayed cord clamping (2 to 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
pathologic hyperbilirubinemia: unconjugated
pathologic hyperbilirubinemia: 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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