![]() ![]() Consider d/c if well and bloods normalĮarly consult with paediatric gastroenterologist F/up GP in 1 to 2 daysįeeding support/fluid replacement. Table 1: Overview of initial investigations and management of neonatal jaundice Unwell neonateĪdmission and early consult with neonatesĬonsider discharge if well and bloods normal. +/- Glucose-6-phosphate-dehydrogenase deficiency (G6PD).+ / - Thyroid Function Test (TFT) (check if infant has had normal neonatal screening).Full Blood Count (FBC) (add reticulocyte count if anaemic).Blood group and Direct Coombs if not previously done. ![]() Serum Bilirubin (SBR) conjugated and unconjugated.Refer to Jaundice – Neonatology Guideline Very difficult to assess level of jaundice by eye alone. Transcutaneous biliometry (TcB) (if available) for immediate estimate of bilirubin.Hydration and weight status (calculate percentage weight loss).Pallor, petechiae, cephalohaematoma, excessive bruising, hepatosplenomegaly.General tone and neurological examination.Family history: ABO/rhesus incompatibility, glucose-6-phosphate-dehydrogenase (G6PD) deficiency, hereditary spherocytosis, prolonged jaundice, thyroid dysfunction.Behaviour: lethargy, cries becoming shrill, arching of the body (bilirubin encephalopathy).Output: Hydration status, dark urine and pale stools (cholestasis), delayed passage of meconium.Feeding: Breast or formula, intake, weight loss, vomiting.Timing of jaundice: Onset and progression of jaundice, 2 weeks prolonged (>3 weeks in preterm).Birth history: Instrumental delivery/birth trauma, gestational age, birth weight.Prolonged jaundice > 14 days in term, >21 days in preterm infants.1,2 Notably, 10% of breastfed babies are still jaundiced at 1 month, but breastmilk jaundice remains a diagnosis of exclusion.Elevated conjugated bilirubin level > 10% total serum bilirubin, or >20micromol/L – neonatal cholestasis (e.g.Rapidly rising total serum bilirubin (> 85 micromol/L per day) 1.Jaundice that occurs in the first 24 hours of life.If there are concerns for a breastfed baby regarding milk supply or poor oral attachment, refer to a lactation consultant for assessment at the Breastfeeding Centre of WA (King Edward Memorial Hospital (KEMH), Community Health breastfeeding support or a private lactation consultant.Īssessment Red flags for pathological jaundice.Increasing oral intake +/- phototherapy is the treatment.Sub optimal intake jaundice or breastfeeding associated jaundice usually appears between 48-72 hours of life, peaks at day 3-5, and is associated with poor intake, poor weight gain and delayed or reduced bowel motions.Feeding - breastfeeding, reducing intake.Genetic: family history, East Asian, Mediterrean.Measure bilirubin concentrations in all babies with jaundice- visual inspection alone is not reliable to estimate the bilirubin concentration.Conjugated hyperbilirubinaemia requires urgent discussion with a paediatric gastroenterologist.Assume a sick neonate who presents with jaundice is septic.This has been partly attributed to earlier hospital discharge (within 48 hours of birth) before the natural peak of bilirubin in the neonate, as well as a result of relaxation of the treatment criteria. ![]() Kernicterus was rarely seen in the decades following the introduction of phototherapy and exchange transfusion however, recent reports suggest it is re-emerging. ![]()
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