Lightning Learning: Neonatal Jaundice
STOP!
Neonatal jaundice (aka hyperbilirubinaemia) refers to the yellow colouration of the skin and the sclera caused by the accumulation of bilirubin.
For most babies jaundice is physiological and not harmful. However, jaundice in the first 24 hours should always be considered pathological.
Physiological jaundice occurs due to a high red cell turnover, together with an immature liver and gut flora.
Approximately 60% of healthy term and 80% of preterm babies develop jaundice in the first week of life. 10% of breastfed babies are still jaundiced at 1 month.(1)
DON’T MISS THE FOLLOWING!
Jaundice is pathological if…
- The child is unwell – THINK SEPSIS!
- Within the first 24 hours of life – haemolysis/sepsis or dehydration.
LOOK
History:
Ask the parent…
- Gestation at birth?
- Type of delivery/complications at birth?
- Any sepsis risk factors? (e.g. maternal pyrexia, baby pyrexia, GBS infection)
- Any wet nappies?
- Feeding history? (e.g. bottle, breast or mixed? Volume, duration of feeds, vomits?)
Examination:
Are they gaining weight appropriately? Refer to the growth chart.
POPS score – are we scoring for sepsis?
Any evidence of jaundice? (e.g. skin and sclera)
Check for signs of dehydration (e.g. sunken fontanelle, dry mucous membranes)
Palpate the abdomen – is there any hepatomegaly or splenomegaly?
Stools pale/chalky? Biliary atresia = emergency that needs specialist intervention.
LEARN
Management:
- Admit for observation, if… <24 hours old OR <35 weeks gestation
- Refer to prolonged jaundice clinic, if… >14 days term OR >21 days preterm
Approach to managing jaundice depends on the age of the neonate and the various factors mentioned. Not all babies need everything!
Relevant Investigations:
- Serum bilirubin (SBR) – capillary blood gas
- Consider U&E if considerable weight loss for their age (>10%)
- If unwell, add septic screen
- Consider urine clean catch
Results:
Compare total SBR to NICE nomogram for gestational age and plot on Treatment Threshold Graph.(2) This will indicate if no therapy, phototherapy OR exchange transfusion is required. Refer to local guidelines regarding specialty referral or discharge follow-up.
