How to evaluate neonatal jaundice in a newborn?

From the Guidelines

Evaluation of jaundice in newborns should begin with a thorough history and physical examination, followed by measurement of total serum bilirubin (TSB) levels, as TSB should be used as the definitive diagnostic test to guide all interventions 1.

Key Evaluation Steps

• Visual assessment alone is unreliable, so transcutaneous bilirubin (TcB) or serum bilirubin testing is essential, with TSB measurement if the TcB reading is within 3.0 mg/dL of the phototherapy treatment threshold, if the TcB exceeds the phototherapy treatment threshold, or if the TcB is ≥15 mg/dL 1.
• For any infant with jaundice in the first 24 hours of life, visible jaundice below the umbilicus, or bilirubin levels approaching exchange transfusion thresholds, immediate medical evaluation is necessary.
• Laboratory workup should include blood type and Coombs test for both mother and infant, complete blood count with peripheral smear, and reticulocyte count, with additional tests such as G6PD screening, liver function tests, and thyroid studies depending on clinical presentation 1.

Management and Follow-up

• Management is guided by bilirubin levels plotted on hour-specific nomograms, with phototherapy initiated when levels exceed age-specific thresholds, and intensive phototherapy recommended at the thresholds based on gestational age, neurotoxicity risk factors, and age of the infant in hours 1.
• Exchange transfusion is reserved for severe cases unresponsive to phototherapy, with care escalated when an infant’s TSB level is at or above the exchange transfusion threshold or within 0 to 2 mg/dL below the exchange transfusion threshold 1.
• Follow-up within 24-48 hours after discharge is recommended for infants with risk factors or early jaundice to monitor bilirubin progression, with the need for additional TSB testing depending on the post-phototherapy TSB level and trajectory 1.

From the Research

Evaluation of Jaundice in Newborns

To evaluate jaundice in newborns, several factors need to be considered, including the level of bilirubin, the age of the infant, and the presence of any underlying medical conditions.

• The diagnosis of jaundice is typically made by physical examination and confirmed by laboratory tests, such as bilirubin levels 2.
• The conjugation state of bilirubin can help guide the provider toward the category of illness, with unconjugated, intrahepatic, or extrahepatic/obstructive causes 3.
• High levels of unconjugated bilirubin can be neurotoxic, and phototherapy is a simple and effective way to reduce bilirubin levels 2, 4.
• The American Academy of Pediatrics recommends routine bilirubin screening for all newborns, with the timing of screening depending on the infant's age and risk factors 5.

Laboratory Tests

Laboratory tests, such as bilirubin levels, can help diagnose and evaluate jaundice in newborns.

• Bilirubin levels can be measured using a blood test, and the results can help determine the severity of jaundice and the need for treatment 2, 5.
• Other laboratory tests, such as liver function tests and complete blood counts, may also be ordered to help determine the underlying cause of jaundice 6, 3.

Treatment

Treatment for jaundice in newborns depends on the severity of the condition and the underlying cause.

• Phototherapy is a common treatment for jaundice, and it involves exposing the infant to special lights that help break down bilirubin 2, 4.
• In some cases, exchange transfusions may be necessary to quickly reduce bilirubin levels and prevent neurotoxicity 5.
• Other treatments, such as hydration and monitoring, may also be necessary to help manage jaundice and prevent complications 2, 4.