Jaundice can be a normal part of the neonatal period (certainly both of my kids looked like the Yellow M&M for a short period in their beginnings); however, hyperbilirubinemia also generates the concern for the development of kernicterus (abnormal accumulation of unconjugated bilirubin in the brain).

Some Important Points to Keep in Mind:

  • Physiologic jaundice in healthy, full-term newborns typically develops during the 2nd – 3rd day of life.
  • Physiologic jaundice in healthy, full-term newborns typically resolves by the 5th or 6th day.
  • Premature neonates are at greater risk! Also, the nomogram only pertains to those greater than 35 weeks gestational age.
  • The nomogram is based on TOTAL bilirubin (not fractionated bilirubin).
  • Consider DDx:
    a. Conjugated – biliary atresia, hepatitis (HSV?), biliary cholestasis, alpha-1-antitrypsin deficiency
    b. Unconjugated – SEPSIS, ABO incompatibility, hereditary spherocytosis, Gilbert’s syndrome, Crigler-Najjar syndrome, glucose-6-phosphate deficiency, breastfeeding vs. breast-milk.

Evaluation (after you’ve determined there is hyperbilirubinemia):

  • Total and Fractionated Bilirubin
  • Blood Type with Rh factor
  • Coomb’s test
  • CBC w/ Diff
  • Reticulocyte count
  • Consider sepsis work-up as well. Remember that these neonates don’t do many things to show you that they are sick… hyperbilirubinemia may be the one red flag that they are able to raise.
Sean M. Fox
Sean M. Fox

I enjoy taking care of patients and I finding it endlessly rewarding to help train others to do the same. I trained at the Combined Emergency Medicine and Pediatrics residency program at University of Maryland, where I had the tremendous fortune of learning from world renowned educators and clinicians. Now I have the unbelievable honor of working with an unbelievably gifted group of practitioners at Carolinas Medical Center. I strive every day to inspire my residents as much as they inspire me.

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  1. This blog is very meaningful, Neonatal jaundice is the one of the main problem with neonates. This can occur when the baby is having higher level of bilirubin in the blood. The bilirubin is a yellowish substance which present in the blood, by replacing the old red blood cells. Ibis Medical is the one of the major manufacturer of the neonatal products which has worldwide distribution network.

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