Jaundice in the first 24 hours of life = always pathological.
Physiological jaundice appears after 24 hrs, resolves within 2 weeks, and is mostly unconjugated.
Biliary atresia → conjugated hyperbilirubinaemia. Severe unconjugated hyperbilirubinaemia (>360 µmol/L) risks kernicterus 🧠.

TSB (Total Serum Bilirubin) measures bilirubin in blood. Elevated bilirubin = jaundice (yellow skin/eyes). Persistent or conjugated rise suggests underlying disease.

🦠 Causes of Neonatal Jaundice

✅ Physiological Jaundice

Appears >24 hrs of life
Peaks at day 3–5
Resolves within 1–2 weeks
Usually no treatment; monitor TSB

🤱 Breast Milk Jaundice

Begins after 1st week, can persist 4–6 weeks
Exclude other causes of prolonged jaundice
Continue breastfeeding, monitor TSB

🩸 Haemolytic Disease (ABO/Rh incompatibility)

Jaundice within 24 hrs
Splenomegaly, pallor
Tests: Direct Coombs, blood group/Rh, TSB, Hb
Management: Phototherapy; exchange transfusion if severe

🦠 Neonatal Sepsis

Jaundice + infection signs (poor feeding, lethargy, temperature instability)
Tests: Blood culture, CRP, FBC, TSB
Management: IV antibiotics + phototherapy

🚫 Biliary Atresia

Jaundice persisting >2 weeks
Pale stools, dark urine
Tests: USS, LFTs, hepatobiliary scintigraphy
Management: Kasai procedure; liver transplant if severe

🧬 Crigler–Najjar Syndrome

Severe jaundice from birth
Neurological symptoms (kernicterus) if untreated
Tests: TSB, genetic testing (UGT1A1 mutation)
Management: Phototherapy; possible liver transplant

📈 Why TSB is Important

Helps determine jaundice severity & need for intervention (e.g., phototherapy, exchange transfusion).
Prevents progression to kernicterus 🧠.
Normal TSB varies with age in hours, but jaundice visible >5 mg/dL;>20 mg/dL requires urgent action.

Cases — Neonatal Jaundice

Case 1 — Physiological jaundice 🌞: A 3-day-old term baby is noted to be jaundiced. Feeding well, no hepatosplenomegaly, baby otherwise healthy. Bilirubin mildly raised, unconjugated. Diagnosis: physiological jaundice due to immature liver conjugation pathways and increased RBC turnover. Managed with reassurance, monitoring, and ensuring good feeding — usually resolves by day 10.
Case 2 — Haemolytic jaundice (pathological, early) ⚡: A 1-day-old neonate (mother O⁻, baby A⁺) presents with jaundice within 12 hours of birth. Bloods: raised unconjugated bilirubin, positive direct Coombs test. Diagnosis: haemolytic disease of the newborn due to ABO incompatibility. Managed with phototherapy, IV fluids, and exchange transfusion if bilirubin rises rapidly.
Case 3 — Prolonged conjugated jaundice 🚨: A 3-week-old infant remains jaundiced. Stools are pale, urine dark. Exam: hepatomegaly. Bloods: raised conjugated bilirubin. Diagnosis: neonatal cholestasis — biliary atresia. Managed with urgent referral to paediatric hepatology for Kasai portoenterostomy before 8 weeks of age.

Teaching Point 🩺: Neonatal jaundice can be: - Physiological (after 24 h, resolves by 10–14 days, unconjugated). - Pathological (early): within 24 h → haemolysis, infection. - Prolonged (>14 days): consider cholestasis (biliary atresia, neonatal hepatitis). Always check: bilirubin type (conjugated vs unconjugated), age of onset, feeding, stool/urine colour. Management ranges from reassurance → phototherapy → exchange transfusion → surgery.

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Neonatal Jaundice

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