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 anaemia
- family history of splenectomy
- maternal exposure to sulphonamides or antimalarials
- hepatosplenomegaly
- microcephaly
- chorioretinitis
- small for gestational age
- cephalhaematoma
- hypertonia
- high-pitched cry
- retrocollis
- opisthotonus
Other diagnostic factors
- perinatal asphyxia
- macrosomia
- plethora
- hypotonia
- lethargy
Risk factors
- Asian
- American-Indian
- maternal diabetes
- oxytocin in labour
- low birth weight
- decreased gestational age
- decreased caloric intake and weight loss
- breastfeeding
- delayed cord clamping (2-3 minutes)
- genetic factors
Diagnostic investigations
1st investigations to order
- transcutaneous bilirubin (TcB)
- total serum bilirubin
- direct Coombs' test
- direct serum bilirubin
Investigations to consider
- haematocrit
- FBC
- 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
physiological hyperbilirubinaemia
pathological hyperbilirubinaemia: unconjugated
pathological hyperbilirubinaemia: conjugated
breastfeeding/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.
Guidelines
- Jaundice in newborn babies under 28 days
- 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?
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