UMEM Educational Pearls

Category: Pediatrics

Title: Neonatal Jaundice (submitted by Brad Cotter, MD)

Posted: 4/29/2016 by Mimi Lu, MD (Emailed: 4/30/2016) (Updated: 4/30/2016)
Click here to contact Mimi Lu, MD

Neonatal jaundice- Incidence ~85% of term newborns

Bili levels are EXPECTED to rise during first 5 days of life

Be aware of CONJUGATED hyperbilirubinemias (biliary atresia, infection)

Majority of cases due to increase in unconjugated (indirect) bilirubin 2/2 residual fHgb breakdown and insufficient capacity of hepatic conjugation

Severe hyperbilirubinemia (Tbili >20mg/dL) <2% of term infants 

Acute bilirubin encephalopathy(ABE)- Hypertonia, arching, opisthotonos, fever, high pitched cry


Kernicterus (5% of ABE)-CP, MR, auditory dysfunction, upward gaze palsy


When to refer for phototherapy/exchange transfusion

  1. Reference published guides (attached)
  2. Online calculator-



“Evaluation and Treatment of Neonatal Hyperbilirubinemia” Muchowski MD, Naval Hospital Camp Pendleton Family Medicine Residency Program, Camp Pendleton, California; Am Fam Physician. 2014 Jun 1;89(11):873-878.

Management of Hyperbilirubinemia in the Newborn Infant35 ore More Weeks of Gestatiion, Pediatrics 2004 July; 114(1)


1604300118_F3.large.jpg (259 Kb)