This document provides guidance on managing neonatal jaundice. It discusses how to suspect, measure, diagnose, approach, manage, and educate parents about physiological and pathological jaundice. Key points include that 60-80% of newborns develop jaundice, jaundice persisting beyond 14 days requires further investigation, and physiological jaundice is generally harmless and does not require treatment beyond observation.

1. DR.FADI ALFAQAWI
MEDICAL OFFICER
UNRWA
10th FEB 2013
NEONATAL JAUNDICE
1-PHYSIOLOGICAL
Email: dr.alfaqawi@yahoo.co.uk

2. Objectives:
1-How to
-Suspect?
-Measure?
-Diagnose?
2-How to approach? And When to
refer to hospital ?
3-How to manage ?
3-What to tell parents ?
4-To Vaccinate or not ?

3. Introduction:
 ~60% of term and 80% of preterm babies
develop jaundice in the first wk of life.
 10% of BF babies are still jaundiced at
1 month.
 For most babies, jaundice is not an indication
of an underlying disease (termed 'physiological
jaundice') is generally harmless.
 Prolonged jaundice –persisting beyond the
first 14 days in term babies and beyond 21
days in PT babies.

4. Introduction:

5. How to suspect:
Babies are more likely to develop significant
hyperbilirubinaemia if they have:
 gestational age under 38 weeks.
 a previous sibling with NJ requiring
phototherapy.
 mother's intention to breastfeed exclusively
 Visible jaundice in the first 24 hours.

6. How to measure: Kramer’s
Index
 When looking for
jaundice (visual
inspection):
1-check the naked
baby in bright &
preferably natural light
2-examine the sclerae,
gums and blanched
skin is useful across all
skin tones.
1- Face 5 mg /dl
2-Upper trunk 10
3-Lower trunk & thighs 12
4-Arms &lower legs 15
5-Palms and soles
>15

7. How to measure: TC
Bilirubinometer
 Use a TC bilirubinometer in
babies with GA of 35 weeks or
more and PN age of >24 hours
 If a TC bilirubinometer is not
available, measure the serum
TB.
 If a TC bilirubinometer
measurement > 250μmol/l (15
mg/dl) … check the result by
measuring the serum TB

8. How to diagnose: Causes
 1. Appearing within 24 hours of age
-Hemolytic disease of newborn: Rh, ABO and minor group
incompatibility
-Infections: intrauterine viral, bacterial; malaria
-G-6PD deficiency
 2. Appearing between 24-72 hours of life
-Physiological
-Sepsis neonatorum
-Polycythemia
-Concealed hemorrhages: cephalhematoma, subarachnoid bleed,
IVH.
-Increased enterohepatic circulation
 3. Appearing after 72 hours
-Sepsis neonatorum
-Neonatal hepatitis
-Extra hepatic biliary atresia

9. Why to diagnose:

10. Physiological Jaundice:
 Immaturity in bilirubin metabolism at multiple
steps...
 Characteristics:
· First appears between 24-72 hours of age
· Maximum intensity seen on 4-5th day in term and
7th day in preterm neonates
· Does not exceed 15 mg/ dl
· Clinically undetectable after 14 days.
· No treatment is required but baby should be
observed closely for signs of worsening jaundice.

11. Pathological Jaundice:
1-Clinical jaundice detected before 24 hours of age.
2-Rise in serum bilirubin by > 5 mg/dl/day.
3-Serum bilirubin >15 mg/dl.
4-Clinical jaundice persisting beyond 14 days of life.
5-Clay/white colored stool and/or dark urine staining
the clothes yellow.
6-Direct bilirubin >2 mg/ dl at any time.
*One should investigate to find the cause.
*Treatment is required in the form of phototherapy or
EPT.

12. How To Approach:
 Check birth wt, GA ,PN age.
 FH/o Jaundice or anemia or neonatal death..
 Maternal and perinatal history…
 Ask when jaundice was first noticed ?
 Assess clinical condition…
 Physiological or Pathological…
 Look for clinical picture of kernicterus in
Newborns..

13. When to refer to hospital:

14. Refer for further investigation if:
 Clinically unwell… poor feeding and lethargy …
 Jaundice within 24 hours of life.
 Jaundice below umbilicus, corresponding to serum bilirubin of
12-15 mg/dl (200-250 μmol/l ).
 Jaundice up to level of the sole of the feet - likely to need
exchange transfusion.
 Rapid rise of serum bilirubin of more than 8.5 μmol/l /hour
(>0.5 mg/dl/hour).
 Prolonged jaundice of >14 days - other causes/conditions
need to be excluded e.g. neonatal hepatitis, biliary atresia.
 Family history of significant haemolytic disease or kernicterus
 Clinical symptoms/signs suggestive of other diseases e.g.
sepsis.
 Direct bilirubin >20 %

15. Reduce level of bilirubin and prevent its toxicity by:
1-Early feeds and adequate hydration.
2-Reduction of Bilirubin by (Threshold table):
1-Phototherapy 2-IVIG 3-EBT.
How to manage in
general :

16. What to tell parents:
 Offer parents or carers information about NJ that is tailored to their needs
and expressed concerns. Care should be taken to avoid causing
unnecessary anxiety to parents or carers. Information should include:
1-Factors that influence the development of significant hyperbilirubinaemia
2-How to check the baby for jaundice
3-What to do if they suspect jaundice
4-The importance of recognising jaundice in the first 24 hours and of seeking
urgent medical advice
5-The importance of checking the baby's nappies for dark urine or pale chalky
stools
6-The fact that NJ is common, &reassurance that it is usually transient and
harmless
7-Reassurance that breastfeeding can usually continue.
8-Provide lactation/feeding support to breastfeeding mothers whose baby is
visibly jaundiced.

17. To vaccinate or not:
 Physiological Jaundice IS NOT a
contraindication.