Neonatal jaundice; causes, clinical assessment

Inadequacy of breastfeeding is a common cause of exaggerated neonatal jaundice during initial few days.

  • Neonatal jaundice is the most common cause morbidity in the first week of life.
    • 60% of term newborns
    • 80% of preterm newborns
  • Neonatal jaundice is the most common cause of re-admission after discharge from birth hospitalization.
    • In neonates is when total serum bilirubin (TSB) concentration exceeds 5 to 7 mg/dL.
      • visible in skin
      • eyes
    • In adults have jaundice visible in eyes when TSB concentration exceeds 2 mg/dL.
  • Increased TSB concentration in neonate results from
    1. increased production
    2. decreased clearance and
    3. re-absorption


  • Jaundice attributable to physiological immaturity of neonates to handle increased bilirubin production is termed as physiological jaundice .
  • ‘Pathological jaundice’ is said to be present when TSB concentrations are not in physiological jaundice .
Pathological jaundice
Presence of one or more of the following conditions would qualify a neonate to have pathological jaundice

What are the causes of pathological jaundice ( neonatal jaundice )

  • Common causes of pathological jaundice in neonate include:
    • Hemolysis
    • Decreased conjugation
    • Increased enterohepatic circulation
    • Extravasated blood


  • Blood group incompatibility
  • enzyme deficiencies
  • autoimmune hemolytic anemia

Decreased conjugation

  • Due to liver enzyme immaturity

Increased enterohepatic circulation

  • Lack of adequate enteral feeding that includes insufficient breastfeeding or the infant not being fed because of illness, GI obstruction

Extravasated blood

  • Cephalhematoma, extensive bruising increased the risk of neonatal jaundice.


The parents should be counselled.

Visual inspection of neonatal jaundice.

Visual inspection of neonatal jaundice

Inadequacy of breastfeeding is a common cause of exaggerated jaundice during initial few days (breastfeeding jaundice).

All neonates should be examined at every opportunity but not lesser than every 12 hr until first 3 to 5 days of life for jaundice.

At higher risk of jaundice should be identified.

Neonatal jaundice
Higher risk of neonata jaundice

Indications of TSB Measurement in neonatal jaundice

  • Jaundice in first 24 hours.
  • Beyond 24 hrs: If visually assessed, jaundice is likely to be more than 12 to 14 mg/dL (as visual assessment becomes unreliable) beyond this TSB level or approaching the phototherapy range or beyond.
  • Unsure about visual assessment.
  • During phototherapy.


Leave a Reply

%d bloggers like this: