Jaundice in the first 24 hours

always pathological

Causes of jaundice in the first 24 hrs

• rhesus haemolytic disease
• ABO haemolytic disease
• hereditary spherocytosis
• glucose-6-phosphodehydrogenase

Measure and record the serum bilirubin level urgently (within 2 hours) in all babies with suspected or obvious jaundice in the first 24 hours of life

Jaundice in the neonate from 2-14 days

Jaundice in the neonate from 2-14 days is common (up to 40%) and usually physiological. It is due to a combination of factors, including more red blood cells, more fragile red blood cells (HbF) and less developed liver function.

It is more commonly seen in breastfed babies

All unconjugated bilirubin - pathological causes will usually be mixed

The bilirubin peaks at 5-7mg/dl and usually self resolves

May need phototherapy - light increased conjugation of bilirubin

Jaundice after 14 days (prolonged)

If there are still signs of jaundice after 14 days (21 days if premature) a prolonged jaundice screen is performed, including:

• conjugated and unconjugated bilirubin: the most important test as a raised conjugated bilirubin could indicate biliary atresia which requires urgent surgical intervention
• direct antiglobulin test (Coombs' test)
• TFTs