Management of Neonatal Jaundice

Introduction

Jaundice is one of the most common conditions, which needs medical attention in newborn babies. It is caused by high levels of bilirubin in the blood. Globally, about 60% of the term babies and 80% of the preterm babies develop jaundice in the first week of life. In most of the babies, early jaundice is physiological and harmless. However, some babies may develop severe jaundice, which can be harmful if left untreated. High levels of bilirubin can lead to brain damage, which may result in neurodevelopmental impairment such as cerebral palsy, and visual and hearing loss. Hence early detection of neonatal jaundice (NNJ) is very important, followed by timely referral and appropriate treatment.

Risk factors

Risk factors of severe NNJ are as follows:

• prematurity
• low birth weight
• jaundice in the first 24 hours of life
• mother with blood group O or rhesus negative
• glucose-6-phosphate dehydrogenase (G6PD) deficiency
• rapid rise of total serum bilirubin (TSB)
• sepsis
• lactation failure in exclusive breastfeeding
• high predischarge bilirubin level
• cephalohaematoma or bruises
• babies of diabetic mothers
• family history of severe NNJ in siblings

Methods of detection

All babies should be visually assessed for jaundice at every opportunity. Kramer’s rule describes the relationship between serum bilirubin levels and the progression of skin discolouration. Trained primary health workers may use this as a screening tool.

The transcutaneous bilirubinometer (TcB) is a hand-held device that measures the amount of bilirubin in the skin. If available, it may be used in the assessment of NNJ. Mean differences between TcB measurements and TSB levels are large when the bilirubin levels exceed 205 µmol/L (12 mg/dL).

Visual assessment and TcB should not be used to monitor bilirubin levels in the babies on phototherapy.

TSB measurement is the gold standard for detecting and determining the levels of hyperbilirubinaemia. It is used to confirm the levels of bilirubin detected from visual assessment and TcB as well as to monitor the babies on phototherapy.

Treatment

Phototherapy is the mainstay of treatment in NNJ. Phototherapy should be commenced when TSB reaches the phototherapy threshold for NNJ. Phototherapy thresholds are lower in the preterm and low birth weight babies.