Neonatal jaundice presents as yellowish discolouration of the skin, conjunctiva, and sclera. It is caused because of the elevated serum or plasma bilirubin in the newborn period. Although Neonatal jaundice is typically a mild and transient event, it is imperative to screen newborns with jaundice of a more severe presentation of jaundice or whose jaundice not resolving in a typical manner. 

Evaluation can be done by assessing Bilirubin levels using a transcutaneous measurement device or taking blood for total serum or plasma level determination. 

Hemolytic disease etiology of unconjugated hyperbilirubinemia can be identified by investigations like the neonate’s blood group, Coombs test, complete blood cell (CBC), reticulocyte count, blood smear, and G6PD. 

Patients with conjugated hyperbilirubinemia should undergo the serum aminotransferases assessment for evidence of hepatocellular injury, gamma-glutamyl transferase (GGTP) levels for evidence of hepatobiliary disease and prothrombin time, and serum albumin to evaluate for hepatic synthetic function. It should be further supported with ultrasonography and investigations like TORCH titers, urine culture, viral cultures, serologic titers, amino acids, and the a-antitrypsin phenotype.

Treatment / Management

Treating severe hyperbilirubinemia with phototherapy, IV immunoglobulin, or exchange transfusion prevents acute bilirubin encephalopathy and kernicterus.

Risk factors and the serum bilirubin level on the nomogram determines the need for initiation of Phototherapy. Since most of the bilirubin is excreted in the urine as lumirubin, maintaining hydration and urine output is important during phototherapy. Phototherapy should not be used in conjugated hyperbilirubinemia as it may lead to the “bronze baby syndrome” with greyish-brown discolouration of the skin, serum, and urine. 

IV immunoglobulin is indicated if bilirubin levels continue to increase from iso-immune hemolysis if phototherapy fails. 

In case of risk of neurologic dysfunction, Exchange transfusion is indicated with or without an attempt at phototherapy. Phototherapy should be continued after exchange transfusion until the bilirubin reaches a safe discontinuity level.

Reference- Ansong-Assoku B, Ankola PA. Neonatal Jaundice. StatPearls,2021