Yellow discolouration of skin/sclerae from elevated bilirubin (>85 µmol/L) in neonates.
Causes
- • Physiological (day 2–14)
- • Breastfeeding/breast-milk jaundice
- • Haemolysis (ABO/Rh, G6PD)
- • Sepsis
- • Biliary atresia (conjugated)
Clinical features
- • Yellow skin/sclerae
- • Lethargy, poor feeding (if severe)
Investigations
- • Total + conjugated bilirubin
- • FBC, blood film, reticulocytes
- • Coombs test
- • G6PD, TFT
- • USS liver if conjugated
Diagnosis
- • Plot on age-specific bilirubin nomogram
Differential diagnosis
- • Carotenaemia (palms only)
- • Sepsis
- • Hypothyroidism
Management
- • Phototherapy (LED blue 460 nm)
- • Exchange transfusion if >threshold or kernicterus signs
- • Treat underlying cause
Complications
- • Acute bilirubin encephalopathy
- • Kernicterus (choreoathetoid CP, hearing loss)
Clinical pearls
- • Jaundice <24 h is always pathological
- • Conjugated fraction >20% = obstructive — exclude biliary atresia urgently
Educational — verify locally.
