Division of Reproductive Health

Neonatal Jaundice

DRH/ MNH

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 Learning Objectives:

• By the end of this session, the participant

should be able to:
• Define jaundice.
• Describe Types of jaundice.
• Describe causes of jaundice.
• Describe Treatment of Jaundice based on serum
bilirubin levels.

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 Newborn Jaundice Definition.

Jaundice is defined as: Yellow colouration of skin

and mucous membranes.

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 Types of Jaundice.
Physiological Jaundice.
 Babies remains completely
well
 Sets in on day 3 after birth.
 Disappears within 2 weeks.
 Common in newborn
especially in pre-term.
Actions:
 Educate mother/caregiver to
watch out for danger signs.
 Continue breastfeeding until
baby looks and feeds well.
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Pathological Jaundice.
• Jaundice starts on the first day
of life.
• Jaundice lasts longer than 14
days in term baby, 21 days in
preterm infants.
• Jaundice accompanied with
fever or other signs of illness.
• Deep jaundice -- palms and
soles of the baby are deep
yellow.
Actions:
• Look for the cause and treat
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accordingly.
 Causes of Jaundice.
Physiological. Pathological.
• Serious bacterial infection.
• Haemolytic disease - blood group
 Due to normal (Rhesus and ABO) incompatibility.
physiological • Congenital syphilis or other
breakdown of intrauterine infections.
large red • Liver disease - hepatitis or biliary
blood cell atresia.
mass. • Hypothyroidism.
• Asphyxia.
• Birth injuries.
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 Assessing Severity of jaundice
• Jaundice in newborn
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progresses in
cephalocaudal direction
• The extent of 9
yellowness of the skin is
useful to assess the
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level of bilirubin
• Kramer’s criteria are
used to clinically
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estimate severity

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 Clinically Estimating bilirubin level

(nb: Once baby is under phototherapy, these assessments may

be incorrect.)

Jaundice restricted to Serum bilirubin levels

Face and trunk ≤ 12 mg %

On hands and feet ≥ 15 mg %

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 Management of neonatal jaundice
• The aim of management is reducing the level of
bilirubin and preventing CNS toxicity.
• Prevention of hyperbilirubinemia is achieved by Early
and frequent feeding
• Reduction of bilirubin: This is achieved by
phototherapy and/or exchange transfusion.
• The decision to treat depends on the severity and the
cause of jaundice.

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 Side effects of phototherapy

• Increased insensible water loss: breast feed more

frequent and for longer duration.
• Loose green stools: weigh often and compensate with
breast milk.
• Skin rashes: Harmless, no need to discontinue
phototherapy;
• Bronze baby syndrome: occurs if baby has conjugated
hyperbilirubinemia. If so, discontinue phototherapy;
• Hypo or hyperthermia: monitor temperature frequently
and manage appropriately
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