Neonatal Jaundice

Jaundice is clinically detectable in the newborn when the serum bilirubin levels are greater than 85 mol/L. This occurs in approximately 60% of term infants and 80% of preterm infants. Hyperbilirubinaemia is either unconjugated (which is potentially toxic but may be physiological or pathological) or conjugated (not toxic but always pathological). Without treatment, high levels of unconjugated bilirubin may lead to kernicterus.


Physiological jaundice: This results from increased erythrocyte breakdown and immature liver function. It presents at 2 or 3 days old, begins to disappear towards the end of the first week and has resolved by day 10. The bilirubin level does not usually rise above 200 mol/L and the baby remains well. However, the bilirubin level may go much higher if the baby is premature or if there is increased red cell breakdown - eg, extensive bruising, cephalohaematoma.


Risk factors The risk of developing significant neonatal jaundice is increased in: Low birth weight: premature and small for dates. Breast-fed babies. A previous sibling with neonatal jaundice requiring phototherapy. Visible jaundice in the first 24 hours. Infants of mothers who have diabetes. Male infants. East Asians. Populations living at high altitudes. ently for assessment in hospital.