Neonatal Jaundice

Definition

Neonatal jaundice is the hyperbilirubinaemia in newborn infants.

Etiology
  • Physiological:
    • Always unconjugated hyperbilirubinaemia
    • Onset > 24 hours after birth and should resolve within 2 weeks in term baby or 3 weeks if preterm
    • Haemolysis of fetal haemoglobin + immature hepatic metabolism

 

  • Pathological:
    • Onset can be < 24 hours after birth
    • Unconjugated
    • Haemolytic: haemolytic disease of the newborn (most common cause: Rhesus or ABO incompatibility), bleeding (delivery trauma, bleeding disorders)
    • Non-haemolytic: metabolic disorders
    • Conjugated
    • Decreased bilirubin excretion: TORCH infections, biliary atresia
    • Intrahepatic pathology
Clinical Features
  • Transient icterus
    • Physiological: appears > 24 hours post-birth and resolves within 2 weeks if term or 3 weeks if preterm
    • Pathological: can appear < 24 hours post-birth and resolves > 2 weeks if term or > 3 weeks if preterm
  • Complications
    • Acute bilirubin encephalopathy: lethargy, hypotonic, poor feeding
    • Kernicterus
Investigations
  • Mother and baby blood group
  • Direct Antiglobulin Test (DAT)/ Coombs test
  • Baby’s serum bilirubin (unconjugated/ conjugated split)
  • FBE
Management
  • Phototherapy
  • Exchange transfusion
Author