Last reviewed: 25 Oct 2020
Last updated: 28 Apr 2020



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 bilirubinometer
  • total serum bilirubin
  • direct Coombs test
  • direct serum bilirubin
  • hematocrit
  • CBC
  • 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


Vineet Bhandari

Professor of Pediatrics Obstetrics and Gynecology

Drexel University College of Medicine

Chief, Section of Neonatal Medicine

St. Christopher's Hospital for Children/Hahnemann University Hospital/Temple University Hospital




VB declares that he has no competing interests.

Peer reviewersVIEW ALL

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.

Consultant Neonatologist


Medway Maritime Hospital




HM declares that she has no competing interests.

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