See also Neonatal Jaundice, which contains graphs indicating treatment levels.

The Significance of Jaundice

• Although 50-60% of newborn infants develop jaundice it cannot be assumed it is either mild or "physiological" unless conscious evaluation, examination and investigation has taken place.
• The significance of any serum bilirubin estimation depends upon the maturity and postnatal age of the infant, the clinical status of the infant and the aetiology of the jaundice.

• Jaundice is important because in itself it may cause kernicterus and because it may be a presenting sign of an apparently unrelated condition.  For example, Chinese boys with jaundice may have G6PD deficiency.

Indications for Paediatric Referral

• Jaundice requires paediatric evaluation in the following situations and whenever there is a possibility that hyperbilirubinaemia may indicate or cause pathology.

1. Clinically present before 24hrs of age.
2. Whenever other symptoms and/or signs of illness are present. When SBR >200 μmol/L on the second day of life.
3. When SBR >250 μmol/L
4. When jaundice is of late onset (7-10 days or later) or is prolonged with SBR >200 μmol/L after 7-10 days of life.

Management of Neonatal Jaundice

• Management is dictated both by the bilirubin level and by the underlying condition.  For example, a significant haemolytic condition may indicate earlier or longer treatment.

• Treatment may consist of both ensuring adequate hydration, and encouraging photo-degradation of unconjugated bilirubin in the skin by the provision of phototherapy. This may prevent serum bilirubin levels rising to levels where exchange transfusion would be necessary.  Phototherapy is very effective at preventing the need for an exchange transfusion.

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