Management of Neonatal Jaundice

 

Reviewed at Clinical Practice Meeting
August
2012
Clinical Guidelines Back Newborn Services Home Page
Assessment Management (including graphs) Atypical Jaundice Related Documents

See also Neonatal Jaundice on the Postnatal Ward.

Assessment

The evaluation of the jaundiced newborn infant must include a thorough history and physical examination, with particular emphasis on the state of hydration and consideration of the possibility of an acute haemolytic process and/or infection.

  1. Review maternal blood group.
  2. Request infant's blood group and Coomb’s test if mother's blood group is O.
  3. Check SBR (note that a direct SBR very rarely indicated within the first 5 days of life).
  4. Haemoglobin, WBC and differential, and reticulocytes if suspicion/evidence of haemolysis.
  5. Urine for microscopy and a culture only if clinical suspicion of a urinary tract infection.
  6. If galactosaemia is suspected, then discuss an urgent serum assay through the National Testing Laboratory. Urine samples for reducing substances are not reliable nor specific.

Management

  • Treatment Guidelines for Term Infants without Haemolysis
    • Click on the picture on the right
SBR Chart - term without haemolysis.jpg (165401 bytes)
  • Treatment Guidelines for Preterm Infants or Infants with Haemolysis
    • Click on the picture on the right
SBR Chart - preterm and haemolysis.jpg (152120 bytes)

It is important to maintain normal hydration and nutrition of the jaundiced newborn infant. This may be achieved by the encouragement of breastfeeding, the provision of additional oral fluids or may require the intravenous administration of fluid. There is no evidence to support the administration of excessive quantities of fluid and most infants will not need extra fluids.

Phototherapy

Phototherapy causes photodegradation of bilirubin in the infant's skin.

Infants receiving phototherapy should be under paediatric supervision.

Administration of Immunoglobulin (see protocol)

Exchange Transfusion

With appropriate management, exchange transfusion should rarely be required.

Atypical Jaundice

References

1 Neonatal Jaundice. NICE Clinical Guideline 2008. National Institute for Health and Clinical Excellence, 2010.
2 Management of Hyperbilirubinaemia in the Newborn Infant 35 or More Weeks of gestation. AAP Guideline. Paediatrics 2004;114;297