A Comprehensive Review of Neonatal Jaundice Etiology, Diagnosis, and Management

A PROJECT REPORT ON
A COMPREHENSIVE REVIEW OF NEONATAL JAUNDICE

SUBMITTED TO
ASSAM SCIENCE AND TECHNOLOGY UNIVERSITY, GUWAHATI
AND
GIRIJANANDA CHOWDHURY INSTITUTE OF PHARMACEUTICAL SCIENCE,
GUWAHATI
Submitted in the fulfillment of the degree of

BACHELOR OF PHARMACY
Under the valuable guidance of
MISS SALEMA KHATUN
ASSISTANT PROFESSOR (GIPS, GUWAHATI)
DEPARTMENT OF PHARMACEUTICS
Submitted by
BISHWAPRATIM SAIKIA
B PHARM 8TH SEMESTER
ROLL NO : 200510011014
REG NO : 262505120
GIRIJANANDA CHOWDHURY INSTITUTE OF
PHARMACEUTICAL SCIENCE (GIPS)
(A Unit of Shrimanta Shankar Academy) Approved by AICTE &

PCI,
New Delhi, affiliated to Assam Science and Technology
University.
N.H.37, Hatkhowapara, Azara, Guwahati-781017
Telephone: 0361-2843405, Email: gips_guwahati@rediffmail.com
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CERTIFICATE
This is to certify that the review work entitled “A COMPREHENSIVE

REVIEW OF NEONATAL JAUNDICE” is being submitted by Bishwa
Pratim Saikia, Roll nо. 200510011014, Regd. No. 262505120 in partial
fulfillment of the requirement for the award of Degree of Bachelor of Pharmacy
in Girijananda Chowdhury Institute of Pharmaceutical Science (GIPS),
affiliated to ASTU, Guwahati, Assam is a bonafide assignment which had
been carried out during the academic session 2024.
I wish him all success in life.
VERIFIED BY
DR. BHANU PRATAP SAHU

PRINCIPAL
GIPS, GUWAHATI

PCI,
New Delhi, affiliated to Assam Science and Technology University.

-------------------------------------------------------------------------------------------------------------------------
-----
CERTIFICATE
This is to certify that the review work entitled “A COMPREHENSIVE

REVIEW OF NEONATAL JAUNDICE” is being submitted by Bishwa
Pratim Saikia, Roll nо. 200510011014, Regd. No. 262505120 in partial
fulfilment of the requirement for the award of Degree of Bachelor of Pharmacy
in Girijananda Chowdhury Institute of Pharmaceutical Science (GIPS),
affiliated to ASTU, Guwahati, Assam is a bonafide assignment which had
been carried out during the academic session 2024.
I wish him all success in life.
SUPERVISED BY
MISS SALEMA KHATUN

ASSISTANT PROFESSOR
GIPS, GUWAHATI
DEPARTMENT OF
PHARMACOLOGY

PCI,
New Delhi, affiliated to Assam Science and Technology University.

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-----
DECLARATION
I hereby declare that the review work entitled “A
COMPREHENSIVE REVIEW OF NEONATAL JAUNDICE” is
a bonafide and review work carried out by me under the supervision
of Miss Salema Khatun, Assistant professor, Department of
Pharmacology, Girijananda Chowdhury Institute of
Pharmaceutical Science (GIPS), affiliated to ASTU, Guwahati,
Assam. The work embodied in this review work is original and has
not been submitted in part or full for the award of degree, diploma,
associateship or fellowship of any other university or institution.
BISHWA PRATIM SAIKIA

B.PHARM 8TH SEMESTER
ROLL NO: 200510011014
REG NO: 262505120
ACKNOWLEDGEMENT
I would like to take this opportunity to express sense of gratitude for

the guidance, assistance, encouragement and support of Miss Salema
Khatun in making the Project and this Project report successful, which
has been structured under his valued suggestion. He helped me to
accomplish the challenging task in a very short period of time. I
would also like to express my gratitude to my parents who has also
helped me to carry out this work. Last but not the least; I thank my
almighty God for his blessing showed on me during this period.
Abstract:
Neonatal jaundice is a common condition characterized by the yellowing of the skin and eyes
due to elevated bilirubin levels in newborns. This review examines the impact, treatments,
prevention strategies, and current literature surrounding neonatal jaundice. Neonatal jaundice
is a common condition characterized by the yellowing of the skin and eyes due to elevated
bilirubin levels in newborns. This review examines the impact, treatments, prevention
strategies, and current literature surrounding neonatal jaundice.
Keywords: Neonatal jaundice, bilirubin, hyperbilirubinemia, treatment, prevention,

phototherapy, exchange transfusion, risk factors.
Aims and objectives of review:
The primary objective of this review is to provide a comprehensive synthesis of current

literature on neonatal jaundice, covering its etiology, diagnosis, management, and prevention
strategies. Specifically, the review aims to:
1. Impact of neonatal jaundice in human and worldwide

2. Treatment
3. Preventive measures
By addressing these objectives, this review seeks to provide clinicians, researchers, and
policymakers with a comprehensive understanding of neonatal jaundice and inform strategies
for its prevention and management, ultimately improving the care and outcomes of newborns
affected by this common condition.
Table of content
Serial Contents Page No.

Number
1 Introduction 1
1.1 Etiology 4
1.2 Clinical Presentation and Diagnosis 7
1.3 Laboratory tests and diagnostic criteria 7
1.4 Diagnostic Criteria 9
1.5 Complications and Long-term Effects 10
2 Impact of neonatal jaundice 13
2.1 Individual impact 14
2.2 Global impact 15
3 Treatments 17
3.1 Non-pharmacological interventions 18
3.2 Pharmacological approaches 19
3.3 Herbal approaches 20
4 Prevention 22
4.1 Primary Prevention: Preventing Jaundice 23
4.2 Secondary Prevention: Assessing At-Risk Infants 23
5 Literature review 24
6 Conclusion 33
7 References 35
List of tables
Sl. No. Name of tables Page number

1 Modern treatment 19
approaches for neonatal
jaundice
2 Herbal treatment approach 21
for neonatal jaundice
1.Introduction:
1.1.Etiology
1.2.Clinical Presentation and Diagnosis
1.3.Laboratory tests and diagnostic criteria
1.4.Diagnostic Criteria
1.5.Complications and Long-term Effects
1
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Girijananda Chowdhury University

1. Introduction:
Jaundice is a medical condition characterized by yellowing of the skin and eyes due to high
levels of bilirubin in the blood. The term jaundice, derived from the French word jaune,
meaning yellow, is a yellowish discoloration of the skin, sclerae, and mucous membranes that
is caused by tissue deposition of pigmented bilirubin. Jaundice is also known as icterus, from
the ancient Greek word ikteros, signifying jaundice. Jaundice is a common clinical sign in
newborns, especially during the first 2 weeks after birth. The first description of neonatal
jaundice and bilirubin staining of the newborn brain goes back to the eighteenth century. The
finding of jaundice on physical examination is an indicator of hyperbilirubinemia. 1It is a
common clinical problem that can occur in individuals of all ages. Jaundice can be caused by
various factors, including liver disease, obstruction of the bile ducts, and certain medical
conditions. The presence of jaundice is often indicative of an underlying health issue, making
it important for healthcare professionals to accurately diagnose and manage this condition.
Jaundice (neonatal icterus), known as yellowish baby is a condition where the yellowing of
the skin and sclera in newborns, due to increased levels of bilirubin in the blood
(hyperbilirubinemia) which subsequently causes an increase in bilirubin in the fluid outside
the cell (extracellular fluid).2
Neonatal jaundice is common, and usually harmless, because of physiological jaundice or

breast-feeding. In some neonates unconjugated bilirubin concentration, coupled with other
risk factors, is sufficient to allow free bilirubin to cross the bloodbrain barrier and cause
kernicterus. Another subgroup of infants is jaundiced because of elevated conjugated
bilirubin; a marker for a number of pathological conditions. Bilirubin measurement must
identify those infants at risk. Transcutaneous bilirubin measurement is increasingly used in
healthy infants, especially before early discharge or at home, to assess the need for laboratory
bilirubin measurement. Transcutaneous measurements are not covered by laboratory quality
assessment schemes. Guidelines on management of neonatal jaundice utilize age in hours and
other risk factors to define bilirubin action thresholds, which may be as low as 100 mmol/L
for sick premature infants, whereas early discharged babies may only present after bilirubin
concentrations are extremely high. Hence, there is a requirement for accurate total bilirubin
measurement from ,100 to .500 mmol/L, with sufficient precision to assess the rate of
bilirubin change with time. Babies presenting with late jaundice always require conjugated
2
bilirubin measurement. It is of concern that many total and direct bilirubin automated kit
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methods suffer from haemolysis interference, while use of in-house methods or modification

of commercial methods has virtually disappeared. External quality assessment has a vital role
in providing data on different methods’ performance, including accuracy, precision and
susceptibility to interference. Laboratories should consider whether their adult bilirubin
methods are suitable for neonates3
Midwives play a crucial role in the prevention and early detection of pathological jaundice
through health education to expectant mothers about dietary requirements and the
significance of exclusive breastfeeding. They are tasked with advising mothers on
recognizing jaundice symptoms and effective home care practices, such as adequate
breastfeeding and early morning sun exposure for the infant. Should these measures not yield
improvement, mothers are advised to seek professional healthcare services 4. Delayed
feeding significantly contributes to the development of jaundice by exacerbating
physiological jaundice's intensity, particularly in premature infants. Newborns whose
mothers have low milk production or are in intensive care and unable to provide colostrum
immediately post-birth accumulate excessive bilirubin, leading to jaundice. Colostrum is
known for its laxative properties, facilitating the expulsion of the newborn’s initial feces,
which contains excess bilirubin5. The community's perception of jaundice as a grave
condition is evident from mothers' inquiries about their newborns' health status regarding
jaundice, highlighting the anxiety and special care required for affected infants. Neonatal
jaundice is usually not harmful and a self-limiting condition; however, very high levels of
bilirubin may cause permanent brain damage, a condition called kernicterus.6
The objective of this dissertation is to provide a comprehensive overview of neonatal

jaundice, encompassing its epidemiology, risk factors, clinical presentation, diagnostic
approaches, management modalities, and long-term implications. The scope of this study
includes a review of relevant literature, an examination of the pathophysiological
mechanisms underlying jaundice, an exploration of the various causes and types of jaundice,
and an evaluation of diagnostic methods and treatment options. The literature review section
will delve into existing research and scholarly articles to analyze the current understanding of
jaundice and highlight any gaps in knowledge. Additionally, the pathophysiology section will
focus on elucidating the underlying mechanisms that contribute to the development of
jaundice, including abnormal bilirubin metabolism and transport.
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1.1 Etiology and types of Neonatal Jaundice:
Neonatal jaundice, characterized by the yellow discoloration of the skin and sclera due to
elevated levels of bilirubin, has multifactorial etiology. Understanding the various factors
contributing to neonatal jaundice is essential for accurate diagnosis and management. The
etiology of neonatal jaundice can be broadly classified into physiological and pathological
causes. The mechanism of neonatal jaundice is the imbalance between bilirubin production
and conjugation, which results in increased bilirubin levels. 7 This imbalance is mainly
because of the immature liver of the neonate and the rapid breakdown of red blood cells,
which may be multifactorial8 9 10 11
. At bilirubin levels of between 85 µmol/L and 120
µmol/L, neonatal jaundice can be diagnosed clinically 1213 14. Kramer described the difficulty
of clinically diagnosing neonatal jaundice in darker pigmented neonates. 15 A study by Moyer
et al. found that the clinical diagnosis of neonatal jaundice is ‘neither reliable nor accurate’. 16
Neonatal jaundice is very common and is present in 60% of term babies and up to 80% of
premature babies.17181920 The main risk factors identified for neonatal jaundice include
prematurity and neonatal sepsis.21222324 In physiological jaundice, it is only the unconjugated
bilirubin levels that are raised, because of immaturity of the liver in the absence of any other
illness. In pathological jaundice, there are underlying conditions that either increase the
production of bilirubin or decrease the excretion. In order to treat pathological jaundice, the
underlying conditions must be treated.25
Physiological jaundice
The most common type of jaundice in newborns is physiological jaundice. This type of
jaundice is normal. Physiological jaundice develops in most newborns by their second or
third day of life. After your baby’s liver develops, it will start to get rid of excess bilirubin.
Physiological jaundice usually isn’t serious and goes away on its own within two weeks. In
rare cases of physiologic hyperbilirubinemia, where bilirubin levels reach toxic high levels,
neurodevelopmental abnormalities could occur including intellectual deficits, athetosis, and
loss of hearing.26 Jaundice attributable to physiological immaturity which usually appears
between 24–72 h of age and between 4th and -5th days can be considered as its peak in term
neonates and in preterm at 7th day, it disappears by 10–14 days of life27.
In physiologic jaundice, bilirubin is predominantly unconjugated, and bilirubin levels in

4
serum do not become higher than 15 mg/dl. More recent guidelines have suggested that even
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bilirubin levels that reach 17 or 18 mg/dl could be considered normal and physiological in an
otherwise healthy full-term neonate2829
Pathological Jaundice
Bilirubin levels with a deviation from the normal range and requiring intervention would be
described as pathological jaundice. Appearance of jaundice within 24 h due to increase in
serum bilirubin beyond 5 mg/dl/day, peak levels higher than the expected normal range,
presence of clinical jaundice more than 2 weeks and conjugated bilirubin (dark urine staining
the clothes) would be categorized under this type of jaundice30
Breastfeeding and Breast Milk-Related Jaundice
The jaundice pattern in exclusively breastfed infants differs from that of formula-fed babies 31.
Typically, jaundice manifests between 24 to 72 hours post-birth, peaks around days 5 to 15,
and resolves by the third week of life, with reported higher bilirubin levels 32. In breastfed
newborns, mild jaundice may persist up to 10 to 14 days post-birth or recur during
breastfeeding.33 While extreme hyperbilirubinemia leading to nuclear jaundice, potentially
resulting in neurological sequelae like hearing loss, mental retardation, and behavioral issues,
is rare, around one-third of breastfed infants exhibit mild clinical jaundice by the third week,
which may last for 2 to 3 months post-birth in some cases 34 35
. Reduced breastfeeding
frequency exacerbates physiological jaundice. 36
37
Hyperbilirubinemia is also linked to maternal breast milk . Approximately 2% to 4% of
exclusively breastfed babies develop jaundice exceeding 10 mg/dL by the third week,
necessitating consideration for prolonged jaundice evaluation 38. Diagnosis of breast milk
jaundice should be contemplated if serum bilirubin is predominantly unconjugated, other
causes of prolonged jaundice are excluded, and the infant remains healthy, vigorous, feeding
adequately, and gaining weight satisfactorily 39. Mothers are advised to continue breastfeeding
more frequently, as bilirubin levels typically decrease gradually. Discontinuation of
breastfeeding is not recommended unless bilirubin levels exceed 20 mg/dL40 .
Hemolytic Jaundice
The primary culprits behind hemolytic jaundice are (a) Rh hemolytic disease, (b) ABO
incompatibility, and (c) Glucose-6-phosphate dehydrogenase (G-6-PD) deficiency along with
5
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minor blood group incompatibility.

 Rh Factor Hemolytic Disease
Rhesus hemolytic disease of the newborns (RHDN) stems from maternal red-cell
alloimmunization.41 Maternal antibodies form against fetal red blood cells when the
fetus possesses a specific antigen, typically occurring when an Rh-positive baby is
born to an Rh-negative mother 42 (and Rh-positive father). Consequently, maternal
immunoglobulin (IgG) antibodies may traverse the placenta into fetal circulation,
leading to a range of symptoms in the fetus, from mild to severe hemolytic anemia
and fetal hydrops 4344. To ensure prompt intervention in neonates suspected to have the
Rh factor, cord blood should be analyzed for blood group and Rh typing, DCT, PCV
(packed cell volume), and serum bilirubin. A reticulocyte count should precede the
initial exchange transfusion (ET). Immediate and intensive phototherapy is necessary
post-birth and should continue until bilirubin levels are 5 mg/dL lower than the
45
threshold for exchange blood transfusion . Lower intervention thresholds for the
treatment of Rh hemolytic disease have been evidenced in preterm infants, with
phototherapy and exchange blood transfusion recommended when levels exceed 0.5%
and 1% of birth weight (kg), respectively 46 . Intravenous immunoglobulin (IVIG) in a
dose of 500 mg/kg every 12 hours for two doses can be administered after the first
ET. Additionally, initiating Phenobarbital at 5 mg/kg/day for five days post the first
ET may be advisable47.
 ABO Incompatibility
The incidence of the incompatibility of the ABO blood groups of the mother and
fetus, when the mother has the blood group O and the newborn has the A or B blood
group is 15–20% of all pregnancies48 . Babies with O-blood group mothers should be
closely checked for and discharged after 72 h. Routine cord blood screening is not
recommended for newborns with O-group mothers49. Jaundice owing to ABO
incompatibility usually appears 24 h after the birth. In the presence of significant
jaundice or jaundice appearing within 24 h, the work up for pathological jaundice
should be done50. Intensive phototherapy is advised at SB 12–17 mg/dl depending
upon postnatal age of the baby. Exchange blood transfusion is indicated at TSB. The
weight at birth as a criterion for phototherapy and ET may be used for preterm
newborns51.
 Jaundice Associated With G6PD Deficiency
6
G6PD deficiency, hereditary spherocytosis, and minor group incompatibilities should

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be managed similarly to ABO incompatibility. G6PD deficiency, the most prevalent

enzymopathy, involves the deficiency of an enzyme in red blood cells 52 and represents
53
a crucial disorder in the hexose monophosphate pathway . Screening for G6PD
deficiency should be contemplated in infants exhibiting severe jaundice from families
with a history of significant jaundice or in regions associated with G-6-PD
deficiency5455. Variations in the UGT1A1 and OATP2 genes, leading to decreased
bilirubin conjugation, play a significant role in the progression of hyperbilirubinemia
in newborns with G6PD deficiency56.
1.2 Clinical Presentation and Diagnosis
Signs and symptoms of neonatal jaundice

 The first symptom is yellow appearance of the skin and the eyes. The infant’s skin
may appear yellow as early as the 1st or 2nd day of life. The jaundice starts around
the head and the face then progresses to the shoulders, arms and the rest of the body
including the legs and feet. The appearance may become more yellow when the baby
is 3 to 4 days old and then slowly gets better. This is called “physiologic” or normal
neonatal jaundice. Most infants have this pattern so no testing is needed.57
 At times, the yellow appearance may occur earlier (shortly after birth), last longer
than 5-6 days or may be much more pronounced. A consultation with your health care
provider is then needed to determine if testing is indicated.
 Along with the skin becoming more yellow, the color of the baby’s urine can change
from very light yellow or very dark brown. In the same manner, the color of the
baby’s stool can vary from a yellow mustard color (normal) to light beige. These 2
color changes in the urine or the stool can indicate that the jaundice is due to different
pigments. Although very rare in the first days of life, the presence of a very dark urine
or light beige stool should be evaluated by a doctor immediately.
1.3 Laboratory tests and diagnostic criteria
Laboratory Tests
 Total Serum Bilirubin (TSB):

o Description: TSB is the sum of unconjugated (indirect) and conjugated (direct)
bilirubin in the blood. It is the gold standard for diagnosing and assessing the
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severity of neonatal jaundice.

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o Procedure: Blood is drawn from the infant, usually through a heel stick, and
analyzed in a laboratory.
o Significance: Elevated TSB levels indicate hyperbilirubinemia, which requires
monitoring and possibly intervention.58
 Transcutaneous Bilirubin (TcB) Measurement
o Description: TcB is a non-invasive method that estimates bilirubin levels by
measuring skin reflectance.
o Procedure: A handheld device is placed on the infant’s forehead or chest to
measure bilirubin levels.
o Significance: TcB is useful for initial screening; elevated levels should be
confirmed by TSB.59
 Direct Coombs Test (DCT)
o Description: DCT detects antibodies attached to red blood cells, indicating
immune-mediated hemolysis.
o Procedure: A blood sample is tested to see if it agglutinates in the presence of
Coombs reagent.
o Significance: Positive DCT suggests conditions like Rh or ABO
incompatibility.60
 Complete Blood Count (CBC)
o Description: CBC measures various components of blood, including red and
white blood cells, hemoglobin, and platelets.
o Procedure: Blood is drawn and analyzed in a laboratory.
o Significance: Can reveal anemia, increased reticulocytes, and signs of
hemolysis.
 Reticulocyte Count
o Description: Measures the number of reticulocytes (immature red blood cells)
in the blood.
o Procedure: Part of the CBC, or as a separate test, blood is analyzed for
reticulocyte percentage.
o Significance: Elevated reticulocyte count indicates active red blood cell
production, often in response to hemolysis.
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 G6PD Enzyme Assay

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o Description: Assesses the activity of the G6PD enzyme in red blood cells.

o Procedure: Blood sample is tested for G6PD enzyme activity.
o Significance: Identifies G6PD deficiency, which can lead to hemolysis and
hyperbilirubinemia.
 Blood Type and Rh Factor
o Description: Determines the blood type and Rh factor of both the mother and
the newborn.
o Procedure: Blood samples from both mother and infant are analyzed.
o Significance: Identifies potential for Rh or ABO incompatibility.
 Liver Function Tests (LFTs)
o Description: Evaluates the health and function of the liver through various
blood tests, including alanine aminotransferase (ALT), aspartate
aminotransferase (AST), and alkaline phosphatase (ALP).
o Procedure: Blood sample is tested for liver enzyme levels.
o Significance: Helps identify liver dysfunction or diseases contributing to
jaundice.61
1.4 Diagnostic Criteria
Visual Assessment
o Description: Initial screening for jaundice involves inspecting the infant's skin
and sclerae for yellow discoloration.
o Procedure: Visual inspection, often under natural light.
o Significance: Visual jaundice typically appears first on the face and progresses
downward as bilirubin levels rise. However, visual assessment is subjective
and can be influenced by factors like lighting and skin tone.62
Bilirubin Levels
o Description: Key diagnostic criteria are based on serum bilirubin levels.
o Procedure: TSB and TcB measurements.
o Significance: Age-specific thresholds guide the need for intervention. For
instance, a bilirubin level above 20 mg/dL often necessitates treatment. 63
Timing and Duration
o Description: Evaluating the timing (onset within the first 24 hours, between
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24-72 hours, or later) and duration of jaundice.

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o Procedure: Clinical history and follow-up.

o Significance: Early-onset jaundice (<24 hours) is often pathological, whereas
jaundice appearing after 24 hours and resolving within two weeks is usually
physiological.
Severity
o Description: Severity is assessed by comparing bilirubin levels to established
age-specific norms.
o Procedure: Serial bilirubin measurements.
o Significance: Determines the need for treatment such as phototherapy or
exchange transfusion. For example, a bilirubin level above 15 mg/dL in a term
infant at 48 hours may require intervention.64
Risk Factor Evaluation
o Description: Assessment of risk factors contributing to jaundice.
o Procedure: Comprehensive clinical evaluation including maternal and neonatal
history.
o Significance: Factors such as prematurity, blood group incompatibility, and
G6PD deficiency can help identify infants at higher risk and guide
management decisions.65
1.5 Complications and Long-term Effects
Neonatal jaundice, characterized by high levels of bilirubin in the blood, can lead to serious
complications if not properly managed. This section provides an elaborate discussion on the
potential complications and long-term effects, supported by research findings.
Acute Complications
 Kernicterus
o Kernicterus is a severe form of bilirubin encephalopathy that occurs when
unconjugated bilirubin crosses the blood-brain barrier and deposits in brain
tissues, particularly the basal ganglia and brainstem nuclei.
o Symptoms include lethargy, hypotonia, poor feeding, high-pitched crying,
10
and, in severe cases, seizures and apnea.

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o If not promptly treated, it can lead to permanent neurological damage.

o Research by Shapiro (2010) emphasizes the need for early detection and
treatment to prevent kernicterus and highlights the importance of monitoring
bilirubin levels in neonates .66
 Acute Bilirubin Encephalopathy

o This is an intermediate stage before kernicterus, marked by early signs of
bilirubin toxicity.
o Clinical manifestations include poor feeding, irritability, and abnormal muscle
tone.
o Morioka et al. (2015) showed that timely intervention with phototherapy or
exchange transfusion can prevent the progression to kernicterus.67
Long-term Effects
 Neurological and Cognitive Impairments

o Long-term sequelae of severe neonatal jaundice include athetoid cerebral
palsy, hearing loss, gaze abnormalities, and intellectual disabilities.
o A study by Newman et al. (2006) linked elevated bilirubin levels to auditory
dysfunction, pointing out that even moderate hyperbilirubinemia can lead to
sensorineural hearing loss .68
o Van Praagh et al. (2011) found that children with a history of significant
neonatal jaundice had higher incidences of developmental delays and learning
difficulties .
 Motor Disorders
o Hyperbilirubinemia has been associated with motor deficits, such as dystonia
and spasticity, due to its neurotoxic effects on the motor regions of the brain.
o Studies reviewed by Johnson et al. (2009) highlight the correlation between
untreated severe jaundice and motor developmental issues later in life .69
 Behavioral Disorders
o Chronic bilirubin encephalopathy can lead to behavioral issues, including
attention deficits and hyperactivity.
o Research conducted by Aslam et al. (2012) shows a significant association
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between neonatal jaundice and the development of ADHD and other

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behavioral disorders in childhood.

 Speech and Language Delays
o Damage to the auditory pathways and areas of the brain responsible for
language can result in delayed speech and language acquisition.
o Boo et al. (2013) report that children with a history of severe neonatal jaundice
often require speech therapy and special education services.
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2. Impact of Neonatal Jaundice in
Humans and Worldwide Individual
Impact
2.1 Individual impact

2.2 Global impact
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2. Impact of Neonatal Jaundice in Humans and Worldwide
Neonatal jaundice is a prevalent condition that manifests in the first few days of life,
characterized by the yellowing of the skin and the sclera of the eyes due to elevated bilirubin
levels. Although it is often a benign condition, it can lead to severe complications if not
properly managed, affecting both individual health outcomes and healthcare systems
worldwide.
2.1 Individual Impact
Health Complications:
 Acute Bilirubin Encephalopathy and Kernicterus: In cases where jaundice

is severe and untreated, it can lead to acute bilirubin encephalopathy, a
condition where bilirubin crosses the blood-brain barrier and causes
neurological damage. This can progress to kernicterus, a form of chronic and
irreversible brain damage. Kernicterus can result in a range of neurological
deficits, including sensorineural hearing loss, cerebral palsy, and cognitive
impairments (Bhutani & Johnson, 2009). These conditions significantly impair
the quality of life and require long-term medical and supportive care.
 Developmental Delays: Even in non-severe cases, elevated bilirubin levels

can affect the neurodevelopmental outcomes of infants. Studies have shown
that high bilirubin levels are associated with developmental delays and
learning disabilities, which can have long-term implications for educational
and social outcomes (Maisels, 2006).
Hospitalization and Treatment:
 Phototherapy: The primary treatment for neonatal jaundice is phototherapy,

which uses blue light to convert bilirubin into a water-soluble form that can be
excreted. While effective, phototherapy requires infants to stay in the hospital,
sometimes for extended periods, which can be stressful for both the infant and
the family (Maisels, 2006).
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 Exchange Transfusions: In severe cases, where phototherapy is not
sufficient, exchange transfusions may be necessary. This invasive procedure
involves replacing the infant's blood with donor blood to rapidly reduce
bilirubin levels. It carries risks such as blood-borne infections, electrolyte
imbalances, and complications from the transfusion process (Burgos et al.,
2008).
Parental Anxiety and Bonding:
 Emotional Stress: The diagnosis and treatment of neonatal jaundice can be a

source of significant anxiety for parents. The sight of their newborn
undergoing phototherapy or the thought of invasive procedures can be
distressing, potentially affecting parental mental health and the early bonding
process with their infant (Burgos et al., 2008).
 Breastfeeding Challenges: Hospitalization and treatment can interrupt

breastfeeding, which is essential for the infant's nutrition and immune
protection. This disruption can further stress parents and complicate feeding
practices (Bhutani & Johnson, 2009).
2.2 Global Impact
Prevalence:
 Incidence Rates: Neonatal jaundice is one of the most common conditions

requiring medical attention in newborns globally. It affects approximately
60% of full-term and 80% of preterm infants in the first week of life. The
prevalence is higher in low- and middle-income countries (LMICs), where
healthcare systems may be less equipped to manage the condition effectively
(Maisels, 2006; Olusanya, Ogunlesi, & Slusher, 2014).
Healthcare Burden:
 Resource Allocation: Managing neonatal jaundice requires significant

healthcare resources, including phototherapy units, trained healthcare
personnel, and follow-up care. In LMICs, the lack of these resources can lead
15
to inadequate treatment and higher rates of complications. The burden on

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healthcare systems is substantial, with hospitals needing to allocate beds and
staff to manage jaundiced infants (Olusanya et al., 2015).
 Training and Awareness: There is often a lack of training and awareness

among healthcare providers in LMICs regarding the early detection and
management of neonatal jaundice. This gap can lead to delayed diagnosis and
treatment, increasing the risk of severe complications (Kaini, 2011).
Economic Impact:
 Direct Costs: The direct costs associated with neonatal jaundice include
hospitalization, phototherapy, exchange transfusions, and follow-up visits.
These costs can be particularly burdensome for families in LMICs, where
healthcare expenses often need to be paid out-of-pocket (Olusanya et al.,
2014).
 Indirect Costs: The long-term care of children who develop disabilities due to
severe jaundice imposes indirect costs on families and society. These include
the costs of special education, rehabilitation services, and the lost productivity
of parents who may need to reduce work hours or stop working to care for
their child (Olusanya et al., 2014).
Public Health Strategies:
 Screening Programs: Implementing universal screening programs for

jaundice in newborns can help in early detection and timely intervention,
reducing the incidence of severe complications. These programs are
particularly crucial in LMICs, where early detection can significantly improve
outcomes (Olusanya, Teeple, & Kassebaum, 2018).
 Education and Training: Enhancing the education and training of healthcare

providers on the management of neonatal jaundice is essential. This includes
training on the use of phototherapy, the recognition of risk factors, and the
management of severe cases (Kaini, 2011).
 Access to Treatment: Ensuring that all healthcare facilities, especially in rural

16
and underserved areas, have access to effective treatments like phototherapy is

Page

critical. Innovative solutions such as low-cost, portable phototherapy units can
help bridge the gap in resource-limited settings (Olusanya et al., 2015).
3. Management and Treatment

3.1 Non-pharmacological interventions
3.2 Pharmacological approaches
3.3 Herbal approaches
17
Page

3. Management and Treatment
Treatment of jaundice is grouped into two main categories: non-pharmacological and

pharmacological therapy. Non-pharmacological usually have phototherapy. Phototherapy is
further classified into conventional, intensive, and exchange transfusion, whereas
pharmacological therapy is further grouped into IV immunoglobulins, phenobarbitone, and
metalloporphyrins.70
3.1 Non-pharmacological interventions
Phototherapy: Phototherapy provides an easy and safe method to treat hyperbilirubinemia

with minimal side effects. Its efficacy mainly depends on the exposure to the phototherapy;
for example, single surface phototherapy is significantly less effective than double surface
phototherapy.71
Double surface phototherapy may be more effective than single surface phototherapy. 72
Spectrum of light source: Special blue tubes with the mark F20T12/BB should be used rather
than F20T12/B lights and Irradiance or energy output may be increased in a phototherapy
unit by lowering the distance of the neonate to within 15–20 cm7374.
Moreover, the use of phototherapy continuously is associated with better outcomes than its
use intermittently. It is recommended not to interrupt phototherapy except during
breastfeeding. Type of phototherapy are as follows.7576
 Conventional phototherapy: This is used in mild and non-hemolytic neonatal

jaundice. Usually used in case the progression is slow
 Intensive phototherapy: This is use in more severe cases, severe elevations in
bilirubin, hemolytic jaundice, or failure of the conventional phototherapy to relieve
the jaundice. Placing the baby on the bili-blanket and using additional overhead
phototherapy units contain blue lights and then lowering the phototherapy units to
within a distance of 15–20 cm are two significant remedies 77
 Exchange transfusion: This is used to remove antibodies that are causing hemolysis
and is used in Rh Isoimmunization and ABO Incompatibility.
18
Page

o Rh Isoimmunization: Always, Blood using for exchange transfusion should
be negative Rh isoimmunization, negative for Rh factor. O (Rh) negative
packed cells suspended in AB plasma will be the best choice. O (Rh) negative
whole blood or cross-matched baby’s blood group (Rh negative) may also be
used in an emergency 7879
o ABO Incompatibility: Only O-blood group should be used for exchange
transfusion in newborns with ABO incompatibility. The best choice would be
O group (Rh compatible) packed cells which are suspended in O group/AB
plasma whole blood (Rh compatible with baby).
o Other situations: In case of the Cross-matched with baby’s blood group blood
volume used or double volume exchange should be kept in mind.
 Blood Volume Used: Partial exchange is done at birth in Rh hemolytic
disease: 50-ml/kg of packed cells.
 Double Volume Exchange: 2 × (80–100 ml/kg) &times birth weight
(kg)
3.2 Pharmacological approaches
Pharmacological treatment of neonatal jaundice can further be categorized into different

subheadings
Modern treatment approaches:
Drug name Mechanism of action Adverse effects Reference

80
Zinc protoporphyrin Metalloporphyrins are Deleterious alterations in iron,
targets for the inhibition of copper lipoprotein,
heme oxygenase. These and cholesterol metabolism,
compounds resemble and adverse physiological
heme but have a effects including nausea,
substitution of the central vomiting, and
metal ion and some side general gastrointestinal
chains of the porphyrin disturbances
ring.
19
81 82 83 84
D-Penicillamine The mechanism of action Thin and vulnerable skin, cutis
Page
of this nitric oxide donor is laxa, elastosis perforans

through the inhibition of serpiginosa, wound healing
HO activity. defects and embryopathy.
85
Phenobarbital Phenobarbital enhances Agitation, somnolence,
UGT in hepatocytes. confusion, CNS depression,
preventing the hyperkinesia, ataxia,
accumulation of bilirubin nervousness, bradycardia,
by improving bilirubin syncope, nausea, vomiting,
conjugation. constipation, Stevens-Johnson
syndrome (rare) , Headache,
hypersensitivity, injection site
reactions, fever, liver damage
and megaloblastic anemia in
chronic users
86 87 88 89
Clofibrate Clofibrate is an Antilipidemic drug and causes
antilipidemic agent that several complications (such as
lowers serum lipids by vomiting, nausea,
reducing very-low density gastrointestinal problems,
lipoproteins rich in loose stools, leucopenia,
triglycerides and may transient cholestasis, muscle
lower cholesterol. cramping, fatigue, pruritus,
Clofibrate is an activator alopecia, renal failure,
of peroxisome abnormal liver function)
proliferator-activated
receptors (PPARs. This
drug increase bilirubin
conjugation and excretion
90 91
Bilirubin oxidase Bilirubin oxidase allows Absence of serious side effects
for the oxidation of has been seen and a milder side
bilirubin, which renders it effect like constipation is seen.
water-soluble and
excretable.
20
Page

3.3 Herbal approaches:
Here is a table summarizing herbal treatments for neonatal jaundice, including the plants
used, parts of the plant, side effects, and the mechanism of action.
Plant Name Parts Side Effects Mechanism of Action Reference

Used
92
Phyllanthus amarus Whole Minimal Inhibits bilirubin
plant production
93
Andrographis Leaves Gastrointestinal Enhances liver function and
paniculata upset bile flow
94
Glycyrrhiza glabra Root Hypertension, Increases liver metabolism
edema and excretion of bilirubin
95
Curcuma longa Rhizome Gastrointestinal Antioxidant properties,
upset reduces liver inflammation
96
Picrorhiza kurroa Rhizome Diarrhea, nausea Stimulates liver function
and bile secretion
97
Berberis vulgaris Root bark Low blood Increases bilirubin
pressure conjugation and excretion
98
Silybum marianum Seeds Allergic reactions Protects liver cells,
enhances regeneration
21
Page

4. Prevention Strategies
4.1 Primary Prevention: Preventing Jaundice
4.2 Secondary Prevention: Assessing At-Risk Infants
22
Page

4. Prevention Strategies
4.1 Primary Prevention: Preventing Jaundice
Physicians should promote and support breastfeeding, advising eight to 12 feedings per day
for the first several days of life.99 100. Formula-fed, full-term infants should consume 150 kcal
per kg per day, which is equivalent to approximately 1 to 2 oz every two to three hours in the
first week of life. Routine supplementation with water or dextrose water is not recommended
in breastfeeding infants because it will not prevent hyperbilirubinemia or decrease total serum
bilirubin levels.101
4.2 Secondary Prevention: Assessing At-Risk Infants
The key to secondary prevention is vigilance on the part of the health care team. All
hospitalized newborns should be routinely monitored by nursing staff and physicians for the
development of jaundice every eight to 12 hours, including at the time that vital signs are
taken.102 Measurement and interpretation of the predischarge bilirubin level can help
determine the timing of outpatient follow-up evaluations. Although jaundice in newborns can
usually be detected by blanching the skin with digital pressure and is usually initially visible
in the face with caudal progression, visual estimation of bilirubin levels is largely inaccurate
and unreliable.103 Transcutaneous bilirubin (TcB) measurement, which is noninvasive, is
equivalent to total serum bilirubin (TSB) measurement.104 105
23
Page

5. Literature review:
24
Page

Literature review
1. Govoni, L., Ricchi, A., Molinazzi, M. T., Galli, M. C., Putignano, A., Artioli, G., Foà,
C., Palmieri, E., & Neri, I. (2019). Breastfeeding pathologies: Analysis of prevalence,
risk and protective factors. Acta Biomedica, 90, 56–62.
https://doi.org/10.23750/abm.v90i4-S.8240
This study by Govoni et al. (2019) explores the prevalence of breastfeeding pathologies
and identifies various risk and protective factors. The research emphasizes the common
challenges faced by breastfeeding mothers, such as mastitis, cracked nipples, and
insufficient milk supply. It highlights that while breastfeeding is beneficial for both
mother and child, various factors can complicate the breastfeeding process.
Key findings include:
Prevalence: Breastfeeding pathologies are common, affecting a significant number of

nursing mothers. The study reports high rates of issues such as nipple pain and mastitis,
which can hinder the breastfeeding experience.
Risk Factors: Identified risk factors include maternal age, parity, and pre-existing
conditions. Younger mothers and first-time mothers are more likely to experience
breastfeeding difficulties.
Protective Factors: Supportive measures such as breastfeeding education, proper latch

techniques, and timely medical intervention are crucial in mitigating these pathologies.
The study also notes the importance of early skin-to-skin contact and rooming-in
practices in promoting successful breastfeeding
Govoni et al. (2019) emphasize the need for comprehensive breastfeeding support programs
to address these pathologies, which can improve breastfeeding outcomes and maternal
satisfaction.
2. Ann Clin Biochem 2008; 45: 452–462. DOI: 10.1258/acb.2008.008076

25
Page

This review article focuses on the biochemical aspects of neonatal jaundice, discussing
the underlying mechanisms and clinical implications. The article covers:
Biochemical Mechanisms: The article explains how the production and conjugation of
bilirubin are critical processes in the development of neonatal jaundice. It details the role
of hepatic enzymes in the conjugation process and the factors that can disrupt these
mechanisms.
Clinical Implications: The review discusses the clinical presentation of jaundice in

newborns and the potential complications if left untreated. It highlights the importance of
early detection and intervention to prevent severe outcomes such as kernicterus.
Diagnostic Methods: Advances in diagnostic methods, including transcutaneous

bilirubinometry and serum bilirubin testing, are reviewed. These methods improve the
accuracy of jaundice assessment and help in timely management.
The article underscores the importance of understanding the biochemical basis of

jaundice to develop effective treatment strategies and improve neonatal care outcomes.
3. Maryunani. (2013). Trans Info Media. Jakarta. West Nusa Tenggara in 2018. NTB:
Department of Health. Accessed through the Indonesian Health Profile. Indonesian
Health Profile 2015. Indonesia Health Profile. https://doi.org/doi:10.1111/evo.12990
at 16.07 WIB.
Maryunani (2013) provides a comprehensive overview of the health profile in West Nusa
Tenggara, with a specific focus on maternal and child health. Key points include:
Health Statistics: The report includes data on neonatal jaundice prevalence and other
maternal and child health indicators in the region. It highlights the challenges faced by
healthcare providers in managing these conditions.
Healthcare Infrastructure: The report discusses the state of healthcare infrastructure,

including the availability of medical facilities, equipment, and trained personnel. It
emphasizes the need for improvements in healthcare delivery to better manage neonatal
conditions like jaundice.
26
Page

Intervention Programs: Various health intervention programs aimed at improving
maternal and child health outcomes are reviewed. These include breastfeeding promotion,
immunization drives, and nutritional support initiatives.
The report calls for continued efforts to enhance healthcare services and support for
mothers and newborns in West Nusa Tenggara to reduce the incidence of neonatal
jaundice and other health issues.
4. Otsuka, Dennis, Tatsuoka, & Jimba. (2008). The relationship between breastfeeding
self-efficacy and perceived insufficient milk among Japanese mothers. Journal of
Obstetric, Gynecologic & Neonatal Nursing, 37(1), 546–555.
https://doi.org/10.1111/j.1552-6909.2008.00277.x
Otsuka et al. (2008) investigate the relationship between breastfeeding self-efficacy and
perceived insufficient milk supply among Japanese mothers. The study's key findings are:
Breastfeeding Self-Efficacy: The concept of self-efficacy is crucial in breastfeeding

success. Mothers with higher self-efficacy are more confident in their ability to
breastfeed, which positively influences breastfeeding duration and satisfaction.
Perceived Insufficient Milk: The perception of insufficient milk supply is a common

concern among breastfeeding mothers. The study finds that lower self-efficacy is
associated with higher levels of perceived insufficient milk, leading to early cessation of
breastfeeding.
Implications for Practice: The findings suggest that enhancing breastfeeding self-
efficacy through targeted interventions, such as counseling and support groups, can help
address perceived milk insufficiency and improve breastfeeding outcomes.
The study highlights the importance of psychological support in breastfeeding practices

and suggests that healthcare providers should focus on boosting mothers' confidence to
promote successful breastfeeding.
5. National Institute for Health and Care Excellence. (2010). Neonatal jaundice
[homepage on the Internet]. Clinical guideline 98. London: Royal College of
Obstetricians and Gynaecologists. [cited 2016 Jun 15]. Available from:
27
https://www.nice.org.uk/guidance/cg98/evidence/full-guideline-pdf-245411821
Page

The NICE clinical guideline on neonatal jaundice provides evidence-based
recommendations for the management of jaundice in newborns. Key aspects include:
Screening and Diagnosis: The guideline recommends universal screening for jaundice in
newborns using transcutaneous bilirubinometry or serum bilirubin testing. Early
identification is crucial for preventing severe complications.
Management Strategies: It outlines various management strategies, including

phototherapy and exchange transfusions for severe cases. The guideline emphasizes the
importance of timely intervention to prevent bilirubin-induced neurological damage.
Parental Guidance: The guideline includes recommendations for educating parents

about the signs and symptoms of jaundice and the importance of monitoring bilirubin
levels.
NICE's comprehensive guideline aims to standardize the care of newborns with jaundice,
improving outcomes through early detection and appropriate management.
6. Kaplan M, Muraca M, Hammerman C, et al. (2002). Imbalance between production

and conjugation of bilirubin: A fundamental concept in the mechanism of neonatal
jaundice. Paediatrics, 110(4), e47. https://doi.org/10.1542/peds.110.4.e47
Kaplan et al. (2002) delve into the biochemical imbalance between bilirubin production
and conjugation as a core mechanism of neonatal jaundice. The study’s highlights
include:
Bilirubin Production: The paper explains that newborns produce bilirubin at a higher
rate due to increased red blood cell turnover. This heightened production requires
efficient conjugation to prevent accumulation.
Conjugation Efficiency: The hepatic enzyme uridine diphosphate-

glucuronosyltransferase (UGT1A1) is critical for bilirubin conjugation. Newborns often
have immature enzyme activity, leading to inefficient bilirubin clearance.
Clinical Implications: Understanding this imbalance aids in developing therapeutic

approaches, such as enhancing UGT1A1 activity through medication or optimizing
28
phototherapy to manage bilirubin levels.

Page

The study provides a fundamental understanding of the physiological processes involved
in neonatal jaundice, highlighting the importance of balancing bilirubin production and
clearance.
7. Brown SB, King RF. (1978). The mechanism of haem catabolism. Bilirubin
formation in living rats by [18O]oxygen labelling. Biochem J, 170(2), 297–311.
https://doi.org/10.1042/bj1700297
Brown and King (1978) investigate the process of haem catabolism and bilirubin
formation using [18O]oxygen labelling in rats. Key findings include:
Haem Catabolism: The study elucidates the biochemical pathway of haem breakdown,
leading to bilirubin formation. It highlights the role of haem oxygenase in catalyzing the
initial step of haem degradation.
Bilirubin Formation: By tracing oxygen atoms in the bilirubin molecule, the study
provides insights into the enzymatic steps involved in converting haem to bilirubin.
Research Implications: Understanding these pathways is crucial for developing

interventions to manage bilirubin levels in neonates with jaundice.
This foundational research contributes to the broader understanding of bilirubin

metabolism, informing clinical strategies for managing neonatal jaundice.
8. Rennie J, Burman-Roy S, Murphy MS, Guideline Development Group. (2010).

Neonatal jaundice: Summary of the NICE guidance. BMJ, 340, c2409.
https://doi.org/10.1136/bmj.c2409
Rennie et al. (2010) summarize the NICE guidelines on neonatal jaundice, providing a
concise overview of recommendations for clinical practice. Key points include:
Early Screening: The guidelines advocate for early and universal screening of jaundice
in newborns to detect elevated bilirubin levels before symptoms become severe.
Treatment Protocols: The guidelines recommend evidence-based treatments such as

29
phototherapy and, in extreme cases, exchange transfusions. These protocols aim to

Page
prevent the progression to severe hyperbilirubinemia and potential neurological damage.

Parental Education: Educating parents about jaundice, its signs, and the importance of
follow-up is emphasized to ensure timely medical attention if bilirubin levels rise.
The summary serves as a practical guide for healthcare providers, aiming to improve the
standard of care for infants with jaundice.
9. Maisels MJ, Kring E. (2006). The contribution of hemolysis to early jaundice in

normal newborns. Pediatrics, 118(1), 276–279. https://doi.org/10.1542/peds.2005-
3042
Maisels and Kring (2006) explore the role of hemolysis in the development of early
jaundice in newborns. Their study findings include:
Hemolysis Contribution: The research demonstrates that hemolysis significantly

contributes to the early onset of jaundice in newborns. Increased destruction of red blood
cells leads to elevated bilirubin production.
Clinical Observations: The study correlates hemolysis with higher bilirubin levels in the
first few days of life, emphasizing the need for close monitoring in infants at risk.
Management Recommendations: Early identification of hemolysis and proactive

management, including phototherapy, are recommended to prevent severe
hyperbilirubinemia.
This study underscores the importance of recognizing hemolysis as a key factor in

neonatal jaundice and suggests tailored interventions to manage affected infants.
10. Adhikari M, Mackenjee H. (2010). Care of the newborn. In: Wittenberg DF,
editor. Coovadia’s paediatrics and child health. 6th ed. Cape Town, South
Africa: Oxford University Press, 129–130.
Adhikari and Mackenjee (2010) provide a comprehensive overview of neonatal care,

including the management of jaundice. Key insights include:
Neonatal Care Principles: The book chapter outlines essential principles of neonatal
care, emphasizing the importance of early detection and management of common
neonatal conditions such as jaundice.
30
Page

Jaundice Management: Strategies for managing jaundice, including the use of
phototherapy and ensuring adequate hydration, are discussed. The authors highlight the
role of breastfeeding in preventing and managing jaundice.
Healthcare Infrastructure: The importance of having a robust healthcare system

capable of providing necessary interventions for newborns is emphasized.
This chapter serves as a valuable resource for healthcare professionals, providing

practical guidance on the comprehensive care of newborns, including those with jaundice.
11. Porter ML, Dennis BL. (2002). Hyperbilirubinemia in the term newborn. Am
Fam Physician, 65(4), 599–606.
https://doi.org/10.1001/archpedi.1969.02100040456007
Porter and Dennis (2002) review hyperbilirubinemia in term newborns, focusing on

causes, diagnosis, and management. Key points include:
Etiology: The review discusses common causes of hyperbilirubinemia, such as

physiological jaundice, breastfeeding jaundice, and hemolytic diseases.
Diagnosis: Emphasis is placed on the importance of accurate diagnosis using clinical

assessment and bilirubin measurement. The use of nomograms to assess risk is also
highlighted.
Management: Treatment options, including phototherapy and exchange transfusion, are

reviewed. The importance of preventing severe hyperbilirubinemia and its complications,
such as kernicterus, is emphasized.
This article provides a thorough overview of hyperbilirubinemia management, serving as

a practical guide for family physicians and pediatricians.
12. Kramer LI. (1969). Advancement of dermal icterus in the jaundiced newborn.
Am J Dis Child, 118(3), 454–458.
https://doi.org/10.1001/archpedi.1969.02100040456007
Kramer (1969) investigates the progression of dermal icterus in jaundiced newborns. Key
findings include:
31
Page

Dermal Icterus: The study documents the clinical progression of jaundice in newborns,
observing that dermal icterus typically advances from the head to the toes.
Clinical Assessment: Kramer emphasizes the importance of clinical assessment in

identifying jaundice severity and determining the need for intervention.
Treatment Implications: Early recognition and treatment of advancing jaundice can

prevent complications and improve outcomes.
This seminal study contributes to the understanding of jaundice progression and

highlights the need for vigilant clinical monitoring.
13. Moyer VA, Ahn C, Sneed S. (2000). Accuracy of clinical judgment in neonatal
jaundice. Arch Pediatr Adolesc Med, 154(4), 391–394.
https://doi.org/10.1001/archpedi.154.4.391
Moyer et al. (2000) evaluate the accuracy of clinical judgment in assessing neonatal
jaundice. Key points include:
Clinical Judgment: The study finds that clinical judgment alone is often insufficient for
accurately assessing jaundice severity. Visual assessment tends to underestimate bilirubin
levels.
Diagnostic Tools: The authors advocate for the use of objective diagnostic tools, such as
transcutaneous bilirubinometry, to improve the accuracy of jaundice assessment.
Implications for Practice: Reliance on clinical judgment alone can lead to missed or
delayed diagnoses, underscoring the need for incorporating objective measurements in
routine practice.
This study highlights the limitations of clinical judgment and the need for objective
diagnostic tools to improve jaundice management in newborns.
32
Page

6. Conclusion
33
Page

Conclusion:
Under the direction of Miss SALEMA KHATUN, assistant professor, department of

pharmacology, the current study is about a comprehensive review of neonatal jaundice.
Neonatal jaundice poses significant challenges globally, impacting newborn health and
necessitating timely intervention. In this review, we explored the multifaceted aspects of
neonatal jaundice, beginning with an introduction outlining its clinical significance and
physiological basis.
The impact of neonatal jaundice on both individual infants and public health is profound.
Unmanaged jaundice can lead to severe complications such as kernicterus, resulting in long-
term neurological deficits or even death. Furthermore, the burden of neonatal jaundice is
heightened in low- and middle-income countries due to limited access to healthcare resources
and diagnostic tools.
Various treatment modalities, including phototherapy and exchange transfusions, are

available to manage neonatal jaundice effectively. These interventions aim to reduce serum
bilirubin levels and prevent bilirubin-induced neurotoxicity. However, challenges persist in
ensuring equitable access to these treatments, particularly in resource-constrained settings.
Prevention strategies play a crucial role in mitigating the burden of neonatal jaundice. Early
identification of at-risk infants, breastfeeding support, and maternal education on jaundice
recognition are essential components of preventive efforts. Additionally, advancements in
prenatal screening and genetic testing offer opportunities for targeted interventions to reduce
the incidence of severe jaundice.
The literature review provided insights into the epidemiology, risk factors, biochemical
34
mechanisms, and clinical management of neonatal jaundice. Studies highlighted the

Page

importance of early detection, accurate diagnosis, and timely intervention in optimizing
outcomes for affected infants.
In conclusion, neonatal jaundice remains a significant global health concern, requiring

comprehensive strategies encompassing prevention, early detection, and effective treatment.
By addressing the multifactorial nature of this condition and implementing evidence-based
interventions, we can minimize its impact on newborn health and ensure better outcomes for
infants worldwide.
7. Reference:
35
Page

Reference:
36
Page

1
. Pediatr Rev (2017) 38 (11): 499–510. https://doi.org/10.1542/pir.2015-0132
2
. Govoni, L., Ricchi, A., Molinazzi, M. T., Galli, M. C., Putignano, A., Artioli, G., Foà, C., Palmieri,
E., & Neri, I. (2019). Breastfeeding pathologies: Analysis of prevalence, risk and protective factors.
Acta Biomedica, 90, 56–62. https://doi.org/10.23750/abm.v90i4-S.8240
3
. Ann Clin Biochem 2008; 45: 452–462. DOI: 10.1258/acb.2008.008076
4
. Maryunani. (2013). Trans Info Media. Jakarta. West Nusa Tenggara in 2018. NTB:
Department of Health. Accessed through the Indonesian Health Profile. Indonesian Health Profile
2015. Indonesia Health Profile. https://doi.org/doi:10.1111/evo.12990 at 16.07 WIB.
5
. Otsuka, Dennis, Tatsuoka, & Jimba. (2008). The relationship between breastfeeding self-efficacy
and perceived insufficient milk among Japanese mothers. Journal of Obstetric, Gynecologic &
Neonatal Nursing, 37(1), 546–555. https://doi.org/10.1111/j.1552-6909.2008.00277.x
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. National Institute for Health and Care Excellence Neonatal jaundice [homepage on the Internet].
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A PROJECT REPORT ON

A COMPREHENSIVE REVIEW OF NEONATAL JAUNDICE

Submitted in the fulfillment of the degree of

(A Unit of Shrimanta Shankar Academy) Approved by AICTE &

This is to certify that the review work entitled “A COMPREHENSIVE

I wish him all success in life.

DR. BHANU PRATAP SAHU

(A Unit of Shrimanta Shankar Academy) Approved by AICTE &

New Delhi, affiliated to Assam Science and Technology University.

This is to certify that the review work entitled “A COMPREHENSIVE

I wish him all success in life.

MISS SALEMA KHATUN

(A Unit of Shrimanta Shankar Academy) Approved by AICTE &

New Delhi, affiliated to Assam Science and Technology University.

BISHWA PRATIM SAIKIA

I would like to take this opportunity to express sense of gratitude for

Keywords: Neonatal jaundice, bilirubin, hyperbilirubinemia, treatment, prevention,

The primary objective of this review is to provide a comprehensive synthesis of current

1. Impact of neonatal jaundice in human and worldwide

Serial Contents Page No.

Sl. No. Name of tables Page number

Girijananda Chowdhury University

Neonatal jaundice is common, and usually harmless, because of physiological jaundice or

Girijananda Chowdhury University

The objective of this dissertation is to provide a comprehensive overview of neonatal

Girijananda Chowdhury University

In physiologic jaundice, bilirubin is predominantly unconjugated, and bilirubin levels in

Girijananda Chowdhury University

Breastfeeding and Breast Milk-Related Jaundice

minor blood group incompatibility.

Girijananda Chowdhury University

G6PD deficiency, hereditary spherocytosis, and minor group incompatibilities should

be managed similarly to ABO incompatibility. G6PD deficiency, the most prevalent

Girijananda Chowdhury University

1.2 Clinical Presentation and Diagnosis

Signs and symptoms of neonatal jaundice

1.3 Laboratory tests and diagnostic criteria

 Total Serum Bilirubin (TSB):

severity of neonatal jaundice.

Girijananda Chowdhury University

 G6PD Enzyme Assay

Girijananda Chowdhury University

1.4 Diagnostic Criteria

24-72 hours, or later) and duration of jaundice.

o Procedure: Clinical history and follow-up.

Girijananda Chowdhury University

1.5 Complications and Long-term Effects

and, in severe cases, seizures and apnea.

o If not promptly treated, it can lead to permanent neurological damage.

Girijananda Chowdhury University

 Acute Bilirubin Encephalopathy

 Neurological and Cognitive Impairments

between neonatal jaundice and the development of ADHD and other

behavioral disorders in childhood.

Girijananda Chowdhury University

Girijananda Chowdhury University

2.1 Individual impact

Girijananda Chowdhury University

2.1 Individual Impact

 Acute Bilirubin Encephalopathy and Kernicterus: In cases where jaundice

 Developmental Delays: Even in non-severe cases, elevated bilirubin levels

Hospitalization and Treatment:

 Phototherapy: The primary treatment for neonatal jaundice is phototherapy,

Girijananda Chowdhury University