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Neonatal jaundice

Last reviewed: 10 Nov 2024
Last updated: 21 Nov 2023

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
Full details

Other diagnostic factors

  • perinatal asphyxia
  • macrosomia
  • plethora
  • hypotonia
  • lethargy
Full details

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
Full details

Diagnostic tests

1st tests to order

  • transcutaneous bilirubin (TcB)
  • total serum bilirubin
  • direct Coombs test
  • direct serum bilirubin
Full details

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
Full details

Treatment algorithm

ACUTE

physiologic hyperbilirubinemia

pathologic hyperbilirubinemia: unconjugated

pathologic hyperbilirubinemia: conjugated

breast-feeding/breast milk jaundice

Contributors

Authors

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

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.

  • 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 Guidelines
  • Patient information

    Jaundice in newborn babies: what is it?

    Jaundice in newborn babies: what treatments work?

    More Patient information
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