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 investigations
1st investigations to order
- transcutaneous bilirubin (TcB)
- total serum bilirubin
- direct Coombs test
- direct serum bilirubin
- hematocrit
- CBC
- reticulocyte count
- peripheral blood smear
- blood groups
Investigations to consider
- 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
Gautham K. Suresh, MD, DM, MS
Professor of Pediatrics
Chair of Pediatrics and Pediatrician-in-Chief
Nemours Children's Hospital
Orlando
FL
Disclosures
GKS 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.
Differentials
- Carotenemia
More DifferentialsGuidelines
- 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 leaflets
Jaundice in newborn babies: what is it?
Jaundice in newborn babies: what treatments work?
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