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Neonatal Jaundice in the Emergency Department

Seeing neonates in the Emergency Department makes me nervous... Neonatal jaundice is often physiologic, not pathologic. Almost all newborns will develop a bilirubin level above the normal cutoff for adults (1 mg/dL) within the first week of life. This is due to increased bilirubin production and decreased hepatic bilirubin clearance. Typically, levels will gradually increase, peak around 6-8 mg/dL on the third day of life, and then decline to normal within 2 weeks. Jaundice often occurs at bilirubin levels >5 mg/dL, and many infants will have visible jaundice at some point. This normal process is termed physiologic jaundice of the newborn.

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Articles of Interest

Filtered Sunlight Is Good Cure for Infant Jaundice, Study Says

Filtered sunlight is a cheap, effective way to treat infant jaundice, according to a study by Stanford researchers.

Hyperbilirubinemia

Premature neonates are at greater risk! Also, the nomogram only pertains to those greater than 35 weeks gestational age.

Management of Hyperbilirubinemia in the Newborn Infant 35 or More Weeks of Gestation

Jaundice occurs in most newborn infants. Most jaundice is benign, but because of the potential toxicity of bilirubin, newborn infants must be monitored to identify those who might develop severe hyperbilirubinemia and, in rare cases, acute bilirubin encephalopathy or kernicterus. The focus of this guideline is to reduce the incidence of severe hyperbilirubinemia and bilirubin encephalopathy while minimizing the risks of unintended harm such as maternal anxiety, decreased breastfeeding, and unnecessary costs or treatment.

Nanomeds can cure jaundice faster

The age-old home remedy for jaundice – nimbu paani or lemon juice – has now got a 21st century spin, thanks to Indian scientists.

Neonatal Jaundice

There are two main methods to treat neonatal jaundice: phototherapy and exchange transfusion.1 Most babies will respond well to phototherapy and exchange transfusions are rarely used. The decision to begin treatment is based on treatment threshold graphs produced by NICE. There are different graphs for different gestations and preterm babies have a lower threshold for starting treatment.

Neonatal jaundice: Why haven’t we achieved global access to phototherapy?

In developing regions of the world, neonatal jaundice is a persistent nemesis. It stands apart from other threats to newborn health, like pneumonia, that present with clear and immediate symptoms. The very nature of jaundice, its onset and progression, expose the gaps in existing patterns of newborn health care that help to explain the residual high death and disability rates...

Newborn Jaundice Treatment May Increase Risk of Childhood Seizures

New research suggests that phototherapy – a treatment for newborns with jaundice – could increase children’s risk of developing epilepsy. The finding raises concerns about babies being given the treatment when it’s not absolutely necessary, as the potential risks could outweigh the benefits.

PEM Playbook – Neonatal Jaundice

Most newborns will have some jaundice. Most jaundice is benign. So, how can we sort through the various presentations and keep our newborns safe? When a baby is born with jaundice, it’s always bad. This is pathologic jaundice, and it’s almost always caught before the baby goes home. Think about ABO-incompatbility, G6PD deficiency, Crigler-Najjar, metabolic disturbances, and infections to name a few. Newborns are typically screened and managed.

Resources

BiliTool

BiliTool is designed to help clinicians assess the risks toward the development of hyperbilirubinemia or "jaundice" in newborns over 35 weeks gestational age. Required values include the age of the child in hours (between 12-146 hours) and the total bilirubin in either US (mg/dl) or SI (µmol/L) units.