II. Epidemiology

  1. Jaundice Incidence in full term infants: 60%
  2. Jaundice Incidence in Preterm Infants: 80%

III. Pathophysiology: Physiologic Jaundice

  1. See Breast Feeding Jaundice
  2. Mechanisms of physiologic Neonatal Jaundice
    1. Increased Bilirubin production (2-3 fold over older infants)
      1. High fetal Hemoglobin turn-over (short Half-Life)
    2. Impaired Bilirubin conjugation
      1. Immature hepatic glucuronosyl transferase
    3. Decreased Bilirubin excretion
  3. Physiologic Jaundice
    1. Transient limitation of Bilirubin conjugation (immature hepatic glucuronosyl transferase)
    2. Increased Hemolysis
      1. Hemoglobin drops from 20 to 12 in first week
  4. Exaggerated Physiologic Jaundice
    1. Low glucuronyl transferase (Hepatic immaturity)
    2. Risk factors
      1. Breast Feeding Jaundice
      2. Prematurity
      3. Asian ethnicity
      4. Weight loss

IV. Signs: Jaundice

  1. General
    1. Visual Jaundice indicates Total Bilirubin >4 mg/dl
    2. Physiologic Jaundice is not present on Day 1
    3. Visual inspection is not an accurate screening tool (misses cases of severe Hyperbilirubinemia)
  2. Level of Jaundice correlates with Bilirubin level (inexact)
    1. Jaundice above nipple line
      1. Reliably predicts Bilirubin <12 mg/dl
    2. Less accurate landmarks for estimation of Bilirubin
      1. Head and neck Jaundice: 6 mg/dl Bilirubin
      2. Trunk to Umbilicus: 9 mg/dl Bilirubin
      3. Trunk to knees: 12 mg/dl Bilirubin
      4. Wrists and Ankles: 15 mg/dl Bilirubin
      5. Hands and Feet: >15 mg/dl Bilirubin

V. Differential Diagnosis

VI. Labs: Bilirubin

  1. See Neonatal Bilirubin
  2. Transcutaneous Bili Meter
    1. Accurate in white infants
    2. Overestimates Bilirubin in black infants
    3. Do not use to monitor infants on Phototherapy

VII. Labs: Secondary Cause

  1. See Nonphysiologic Neonatal Jaundice for additional evaluation

VIII. Evaluation: Jaudice Monitoring before hospital discharge

  1. Visually inspect skin with Vital Signs (at least every 8 hours)
    1. Visual inspection alone has low Test Sensitivity (misses cases of severe Hyperbilirubinemia)
    2. Confirming observation with transcutaneous or Serum Bilirubin is preferred
    3. Moyer (2000) Arch Pediatr Adolesc Med 154:391-4 [PubMed]
  2. Obtain Transcutaneous Bilirubin or Serum Bilirubin
    1. Obtain Neonatal Bilirubin based on risk (preferred method)
      1. See Risk Score for Neonatal Hyperbilirubinemia (score of 8 or more indicates testing)
    2. Often part of hospital directed universal screening (e.g. all newborns at 24 hours)
      1. Universal screening is controversial
      2. Estimated to cost >$5 million in U.S. annually to prevent a single case of Kernicterus
      3. Increases Phototherapy rates without evidence that it decreases the risk of Bilirubin Encephalopathy
      4. Trikalinos (2009) Pediatrics 124(4): 1162-71 [PubMed]
    3. Obtain for Jaundice
      1. Neonatal Jaundice in the first 24 hours
      2. Neonatal Jaundice that appears excessive (e.g. below nipple line)
      3. Neonatal Jaundice that is difficult to assess on exam
      4. Do not rely solely on appearance of Jaundice as a screening indication (misses cases of severe Hyperbilirubinemia)

IX. Evaluation: Jaundice Monitoring after hospital discharge

  1. Based on age
    1. Discharge before 24 hours old: Reevaluate by 72 hours old
    2. Discharge before 48 hours old: Reevaluate by 96 hours old
    3. Discharge before 72 hours old: Reevaluate by 120 hours old
  2. Based on risk factors
    1. See Severe Neonatal Hyperbilirubinemia Risk Factors
    2. Number of risk factors dictates timing of follow-up (typically within 24-48 hours)

X. Management

XI. Prevention

  1. Adequate early nutrition and hydration
    1. See Breast Feeding Technique
    2. See Infant Feeding
    3. See Formula Feeding
    4. Do not supplement with dextrose water or plain water
  2. Monitoring
    1. See Evaluation above

XII. Complications

  1. Kernicterus is most linked to nonphysiologic causes
  2. Kernicterus has been associated with physiologic causes
    1. Physiologic Jaundice
    2. Exaggerated Jaundice
    3. Breast Feeding Jaundice

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Related Studies

Ontology: Neonatal Jaundice (C0022353)

Definition (NCI) Jaundice that appears during the neonatal period. In the majority of cases, it appears in the first week of life and is classified as physiologic due to accelerated destruction of erythrocytes and liver immaturity. In a minority of cases it is classified as non-physiologic, appearing in the first twenty four hours after birth, and is associated with underlying diseases including hemolytic disorders, polycythemia, and cephalohematoma.
Definition (MSH) Yellow discoloration of the SKIN; MUCOUS MEMBRANE; and SCLERA in the NEWBORN. It is a sign of NEONATAL HYPERBILIRUBINEMIA. Most cases are transient self-limiting (PHYSIOLOGICAL NEONATAL JAUNDICE) occurring in the first week of life, but some can be a sign of pathological disorders, particularly LIVER DISEASES.
Concepts Sign or Symptom (T184)
MSH D007567
ICD10 P59.9
SnomedCT 299968002, 206474007, 111470007, 276549000, 387712008, 31482007, 30235009
English Jaundice, Neonatal, ICTERUS NEONATORUM, JAUNDICE NEONATAL, JAUNDICE OF NEWBORN, Icterus neonatorum unspecified, Icterus neonatorum, unspecified, Neonatal jaundice, unspecified, Jaundice, neonatal, neonatal jaundice (diagnosis), neonatal jaundice, Jaundice in baby, Jaundice neonatal, Jaundice of newborn, Jaundice, Neonatal [Disease/Finding], babies jaundice, infant jaundice, newborn jaundice, infants jaundice, jaundice baby, jaundice neonatal, baby jaundice, of newborn jaundice, Jaundice;infant, Jaundice;newborn, babys jaundice, jaundice in baby, jaundice newborns, icterus neonatorum, jaundice newborn physiologic, physiologic jaundice in newborn, jaundice infant, jaundice newborn, Neonatal jaundice (finding), Icterus neonatorum, unspecified (disorder), Icterus neonatorum, Neonatal jaundice, Neonatal jaundice (disorder), icterus; neonatorum, neonatorum; icterus, Neonatal jaundice, NOS, Neonatal Jaundice, infantile jaundice, jaundice of the newborn
French ICTERE NEONATAL, Jaunisse du nouveau-né, ICTERE DU NOUVEAU-NE, JAUNISSE DU NOUVEAU-NE, Ictère des nouveau-nés, Ictère néonatal, Ictère du nouveau-né, Jaunisse néonatale
Portuguese ICTERICIA NEONATAL, Icterícia em bebé, Icterícia do recém-nascido, ICTERICIA DO RECEM-NASCIDO, Icterícia Grave do Recém-Nascido, Icterícia neonatal, Icterícia Neonatal
Spanish ICTERICIA NEONATAL, Icterus neonatorum, Ictericia del recién nacido, Ictericia en bebé, ICTERICIA DEL RECIEN NACIDO, ICTERUS NEONATORUM, icterus neonatorum, ictericia neonatal (trastorno), ictericia neonatal, Ictericia neonatal, Ictericia Neonatal
Italian Ittero neonatale, Ittero dei neonati, Ittero del neonato
Dutch geelzucht baby, geelzucht pasgeborene, icterus neonatorum, icterus; neonatorum, neonatorum; icterus, Neonatale geelzucht, niet gespecificeerd, neonatale geelzucht, Hyperbilirubinemie, neonatale, Icterus neonatorum
German neonatale Gelbsucht, Gelbsucht beim Neugeborenen, Icterus neonatorum, Gelbsucht beim Baby, GELBSUCHT NEUGEBORENES, ICTERUS NEONATORUM, IKTERUS NEUGEBORENES, Neugeborenenikterus, nicht naeher bezeichnet, Gelbsucht Neugeborenes, Ikterus, Neugeborenen-, Neugeborenenikterus
Swedish Gulsot hos nyfödda
Japanese シンセイジオウダン, 黄疸-新生児, 新生児生理的黄疸, 新生児黄疸, 生理的黄疸
Finnish Vastasyntyneen ikterus
Czech Ikterus u novorozence, Icterus neonatorum, Novorozenecký ikterus, novorozenecká žloutenka, žloutenka novorozenců, žloutenka novorozenecká
Korean 상세불명의 신생아 황달
Polish Żółtaczka noworodków
Hungarian Neonatalis icterus, Neonatalis sárgaság, Sárgaság a csecsemőben, Sárgaság, neonatalis, Icterus neonatorum
Norwegian Neonatal icterus, Neonatal ikterus, Neonatal gulsott, Icterus neonatarum, Gulsott hos nyfødt

Ontology: Hyperbilirubinemia, Neonatal (C0857007)

Definition (NCI) Increased levels of bilirubin in the blood during the neonatal period. In the majority of cases it is seen in the first week of life and usually there is no underlying disease, however, it may also occur in hemolytic diseases, infections, metabolic disorders, and liver abnormalities.
Definition (MSH) Accumulation of BILIRUBIN, a breakdown product of HEME PROTEINS, in the BLOOD during the first weeks of life. This may lead to NEONATAL JAUNDICE. The excess bilirubin may exist in the unconjugated (indirect) or the conjugated (direct) form. The condition may be self-limiting (PHYSIOLOGICAL NEONATAL JAUNDICE) or pathological with toxic levels of bilirubin.
Concepts Disease or Syndrome (T047)
MSH D051556
SnomedCT 111470007, 281610001, 30235009
Dutch hyperbilirubinemie neonataal, hyperbilirubinemie pasgeborene, hyperbilirubinemie; neonataal, neonataal; hyperbilirubinemie, hyperbilirubinemie, neonataal
German Hyperbilirubinaemie des Neugeborenen, Hyperbilirubinaemie, neonatal, Hyperbilirubinaemie Neugeborenes, Hyperbilirubinämie, Neugeborenen-, Hyperbilirubinämie, neonatale, Neonatale Hyperbilirubinämie, Neugeborenen-Hyperbilirubinämie
Portuguese Hiperbilirrubinemia do recém-nascido, Hiperbilirrubinemia neonatal, Hiperbilirrubinemia Neonatal
Spanish Hiperbilirrubinemia del recién nacido, hiperbilirrubinemia neonatal (trastorno), hiperbilirrubinemia neonatal, Hiperbilirrubinemia neonatal, Hiperbilirrubinemia Neonatal
Swedish Hyperbilirubinemi hos nyfödda
English Hyperbilirubinemia, neonatal, neonatal hyperbilirubinemia, neonatal hyperbilirubinemia (diagnosis), Hyperbilirubinaemia neonatal, Hyperbilirubinaemia newborn, Hyperbilirubinemia neonatal, Hyperbilirubinemia newborn, Hyperbilirubinemia, Neonatal [Disease/Finding], Hyperbilirubinemia During Infancy, Infancy, Hyperbilirubinemia During, During Infancies, Hyperbilirubinemia, newborn hyperbilirubinemia, hyperbilirubinemia newborns, hyperbilirubinemia neonatal, hyperbilirubinemia newborn, Neonatal hyperbilirubinaemia, Neonatal hyperbilirubinemia, Neonatal hyperbilirubinemia (disorder), hyperbilirubinemia; neonatal, neonatal; hyperbilirubinemia, Neonatal hyperbilirubinemia, NOS, Neonatal hyperbilirubinaemia, NOS, Hyperbilirubinemia, Neonatal, Neonatal Hyperbilirubinemia
Japanese シンセイジコウビリルビンケツショウ, シンセイジコウビリルビンケッショウ, 高ビリルビン血症-新生児, 新生児特発性高ビリルビン血症, 新生児高ビリルビン血症, 新生児特発性高ビリルビン血
Finnish Vastasyntyneen hyperbilirubinemia
Czech Novorozenecká hyperbilirubinemie, Novorozenecká žloutenka, novorozenecká hyperbilirubinémie, hyperbilirubinémie novorozenecká, hyperbilirubinemie novorozenců a kojenců
Croatian Not Translated[Hyperbilirubinemia, Neonatal]
French Hyperbilirubinémie des nouveau-nés, Hyperbilirubinémie néonatale, Hyperbilirubinémie du nouveau-né
Polish Hiperbilirubinemia noworodków
Hungarian újszülöttkori hyperbilirubinaemia, Hyperbilirubinaemia, újszülöttkori, Neonatalis hyperbilirubinaemia
Norwegian Nyfødthyperbilirubinemi, Neonatal hyperbilirubinemi, Hyperbilirubinemi hos nyfødte
Italian Iperbilirubinemia neonatale