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Editors

MirkaLumia
LauraMerras-Salmio
IlkkaKetola

Jaundice in the Newborn

Essentials

  • During the first days of life, up to every second full-term newborn develops jaundice, and of prematurely born infants it happens to the majority.
  • Jaundice is caused by excessive accumulation of bilirubin in the tissues.
  • Hospital stay in maternity hospitals is often short and hence the infant may develop jaundice only after discharge from the hospital.
  • Unconjugated bilirubin concentrations exceeding the safety limits may cause neurological injury.
  • Before discharge from the hospital, it is recommended that the bilirubin concentration of a newborn should be measured with either a transcutaneous bilirubinometer or from a blood sample.

Aetiology and symptoms

  • Physiological jaundice peaks at 3-5 days of age.
  • Breast milk jaundice occurs in about 10% of newborns up to 4-6 weeks of age.
  • As children are discharged from the hospital earlier and earlier, the baby may not turn yellow until he or she is at home.
  • Prematurity is the most important predisposing factor to developing jaundice.
  • Blood group immunizations (ABO or Rh immunization) are the most common causes of developing severe newborn jaundice.
  • Other risk factors for jaundice include weight loss of more than 8%, infections, large bruises, caput succedaneum, phototherapy of a sibling and maternal diabetes. In these cases, the baby often turns yellow before 2 days of age.
  • A jaundiced infant appears languid and gets tired easily. Getting only a meager amount of milk and significant loss of weight increase the risk of developing jaundice.

Diagnosis and treatment

  • If the infant develops jaundice only after getting home, the family should contact directly the maternity hospital during the 2 first weeks of life.
  • When the bilirubin concentration exceeds the phototherapy threshold, the jaundice is treated by phototherapyPhototherapy for Neonatal Jaundice and adequate hydration. The phototherapy threshold is dependent on the child's gestational age, birth weight and chronological age.
    • Phototherapy may be carried out in the maternity hospital or also at home, monitored by a hospital at home service.
  • If jaundice persists beyond the age of 2 weeks, it is regarded as prolonged jaundice and its cause must be investigated, then the latest.
  • Breast milk jaundice is the most common type of jaundice in the over 2 week old infants. In these cases, the child appears healthy and gains weight. Discontinuing breastfeeding is not recommended.
  • If jaundice that developed in a newborn infant persists beyond the age of 2 weeks, the conjugated bilirubin should always be determined.
    • Determining the conjugated bilirubin may be performed in primary health care, provided that the result is rapidly available and will not cause a delay in referring the infant to specialized care.
    • If the conjucated bilirubin is > 20% of the total bilirubin or over 20 µmol/l, additional investigations are urgently needed in the specialized care to exclude biliary atresia.
  • If a child develops jaundice after the 2 first weeks of life, he/she should be referred to a paediatric outpatient clinic urgently (appointment within a week) or as an emergency case immediately on the next working day. Performing laboratory tests is not necessary prior to the referral.
  • If it is possible to take blood samples from the child in primary care, it is recommended that, in addition to bilirubin samples, the following tests are performed: basic blood count with platelet count, reticulocyte count, direct Coombs test, blood type test (ABO and Rh), and ALT.

    References

    • Neonatal jaundice. Clinical GuidelineMay 2010. National Collaborating Centre forWomen's and Children's Health
    • Kemper AR, Newman TB, Slaughter JL, et al. Clinical Practice Guideline Revision: Management of Hyperbilirubinemia in the Newborn Infant 35 or More Weeks of Gestation. Pediatrics 2022;150(3). [PubMed]