Neonatal Jaundice

Neonatal jaundice results from accumulation of unconjugated or conjugated bilirubin.

Physiological jaundice appears after the first 24 hours, peaks during the first week and resolves progressively.

Jaundice appearing during the first 24 hours is pathological until proven otherwise.

The major danger of severe unconjugated hyperbilirubinaemia is bilirubin neurotoxicity and kernicterus.

• Yellow discoloration of skin and sclerae
• Progressive cephalocaudal spread with rising bilirubin

Acute bilirubin encephalopathy may cause:

• Poor feeding
• Lethargy
• Hypotonia initially
• High pitched cry
• Hypertonia and opisthotonus
• Seizures

Measure total serum bilirubin rather than estimating severity visually.

Interpret bilirubin according to:

• Postnatal age in hours
• Gestational age
• Haemolysis
• Sepsis
• Clinical instability

Investigate pathological jaundice with:

• Maternal and neonatal blood group
• Direct antiglobulin test
• FBC and reticulocyte count
• Blood film
• G6PD testing where appropriate
• Direct bilirubin when conjugated disease is possible

Use hour specific and gestation specific bilirubin treatment thresholds for phototherapy and exchange transfusion.

• Start intensive phototherapy when the relevant threshold is crossed.

• Maximize exposed skin while protecting the eyes.

• Maintain feeding and hydration.

• Check bilirubin serially.

Urgent exchange transfusion is required when bilirubin reaches the exchange threshold or acute bilirubin encephalopathy develops despite intensive phototherapy.

Phototherapy does not treat conjugated hyperbilirubinaemia.