Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX
To differentiate between physiological and pathological jaundice in neonates, consider the timing of onset, duration, associated symptoms, and specific risk factors NICE CKS. Physiological and breast milk jaundice are common, usually transient and harmless, and typically appear within the first week of life NICE CKS,NICE CG98. Breastfeeding can usually continue with physiological jaundice NICE CKS,NICE CG98.
Indicators suggesting pathological jaundice include:
It is important to note that visual assessment alone is not a reliable indicator of bilirubin level and should not be used to estimate the severity of jaundice NICE CKS,NICE CG98. Bilirubin levels should be measured, with serum bilirubin measurement used for babies in the first 24 hours of life or those with a gestational age of less than 35 weeks NICE CG98.
Indicators suggesting pathological jaundice include:
- Early Onset: Jaundice appearing within the first 24 hours of birth NICE CKS,NICE CG98.
- Late Onset: Jaundice first appearing after 7 days of age NICE CKS.
- Prolonged Duration: Jaundice lasting more than 14 days in babies with a gestational age of 37 weeks or more, or more than 21 days in babies with a gestational age of less than 37 weeks NICE CKS.
- Gestational Age: Babies born at less than 35 weeks gestational age are more vulnerable and require referral for serum bilirubin assessment NICE CKS,NICE CG98.
- General Unwellness: Signs such as lethargy, fever, vomiting, significant weight loss, or irritability NICE CKS.
- Feeding Problems: Poor feeding and concerns about weight, particularly in breastfed infants, as inadequate intake can exacerbate jaundice NICE CKS.
- Stool and Urine Changes: Pale stools and dark urine, which can indicate liver disease NICE CKS.
- Signs of Bilirubin Encephalopathy: Features like atypical sleepiness, poor feeding, irritability, vomiting, hypotonia followed by hypertonia NICE CKS.
- Rapidly Rising Bilirubin: A bilirubin level increasing by more than 8.5 micromol/litre per hour NICE CG98.
- High Bilirubin Levels: A serum bilirubin level greater than 340 micromol/litre in babies with a gestational age of 37 weeks or more NICE CG98.
- Family History: A previous sibling who required phototherapy for neonatal jaundice NICE CG98.
It is important to note that visual assessment alone is not a reliable indicator of bilirubin level and should not be used to estimate the severity of jaundice NICE CKS,NICE CG98. Bilirubin levels should be measured, with serum bilirubin measurement used for babies in the first 24 hours of life or those with a gestational age of less than 35 weeks NICE CG98.