Contents Chapter Topic Page Neonatology Respiratory Cardiology

Physical examination
• General condition: ill-looking if jaundice is severe or if there is presence of some
other illnesses e.g. infection. Neurological signs are present if kernicterus
develops.
• Pallor, presence of cephalohaematoma/subaponeurotic haematoma, petechiae,
purpura, ecchymosis , and hepatosplenomegaly implicate a pathological cause
of jaundice
• Cephalo-caudal progression of severity of jaundice may be seen in some infants,
but correlating with levels of bilirubin is often inaccurate
• Intensity of yellow discoloration in skin and mucosa helps with assessment of the
severity of jaundice
When should a neonate be referred for hospital management? (When to worry?)
The following are indications for referral.
1. Jaundice below umbilicus, corresponding to serum bilirubin of 12-15 mg/dl (200-
250 µmol/L).
2. Jaundice up to level of the sole of the feet - likely to need exchange transfusion.
3. Jaundice within 24 hours of life.
4. Rapid rise of serum bilirubin of more than 8.5 µmol/L/hour (>0.5 mg/dl/hour).
5. Prolonged jaundice of more than 14 days - other causes/conditions need to be
excluded e.g. neonatal hepatitis, biliary atresia.
6. Family history of significant haemolytic disease or kernicterus
7. Clinical symptoms/signs suggestive of other diseases e.g. sepsis.
Laboratory diagnosis
Investigations for NNJ include:
• Total serum bilirubin – sufficient in most cases
• Unconjugated & conjugated fractions in specific conditions e.g. prolonged NNJ
• Infant’s blood group, maternal blood group (if not already known)
• Direct Coomb’s test (if blood group incompatibility is suspected)
• G6PD status (if not known yet)
• Full blood count
• Reticulocyte count
• Peripheral blood film
• Blood culture, urine microscopy and culture ( if infection is suspected)
Treatment
PHOTOTHERAPY
The aim of phototherapy is to prevent potentially dangerous indirect bilirubin levels and
to decrease the need for exchange transfusion, since phototherapy changes bilirubin
into more soluble forms to be excreted in the bile or urine. The effectiveness of
phototherapy is affected by the intensity, or irradiance, of the phototherapy light,
increased irradiance producing increased effectiveness, until the saturation dose of 40
µW/cm 2 /nm of appropriate light is reached. The minimum irradiance is 6-12 µW/cm 2 /nm.
Other factors affecting the effectiveness are the spectrum of light delivered by the
phototherapy unit, the surface area of the infant exposed to phototherapy, and the