What are the indications for referring a newborn with jaundice to a specialist?

Refer a newborn with jaundice to a specialist if there is suspected or obvious jaundice in the first 24 hours of life, and serum bilirubin level should be measured urgently within 2 hours, with urgent review within 6 hours to exclude pathological causes ¹.

Referral is indicated if jaundice first appears at less than 24 hours of age, especially if the baby is unwell or shows signs of bilirubin encephalopathy, such as atypical sleepiness, poor feeding, irritability, vomiting, or hypotonia followed by hypertonia ¹.

Babies with jaundice appearing at more than 7 days of age should be urgently evaluated, if no cause has been identified, as this may indicate underlying pathology ¹.

Referral is also recommended for babies with prolonged jaundice (lasting more than 14 days in babies ≥37 weeks gestation or more than 21 days in preterm babies), to investigate underlying causes such as biliary atresia or other liver diseases ¹.

Additional indications include pale stools and dark urine, which can be signs of biliary atresia or liver disease, warranting specialist assessment ¹.

Any baby showing signs of neurological dysfunction or features of bilirubin encephalopathy should be referred immediately for emergency assessment and treatment, including possible exchange transfusion ¹.