Neonatal jaundiceMANAGEMENT

PEDIATRIC-SPECIFIC PRESENTATIONS · 12 SECTIONS

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504 items

☷ Legend

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Cardiovascular Presentations71▾

Respiratory Presentations52▾

Neurological Presentations83▾

Gastrointestinal Presentations74▾

Genitourinary and Reproductive Presentations48▾

Infectious Disease Presentations148▾

Trauma Presentations89▾

Toxicologic Presentations80▾

Psychiatric Presentations26▾

Musculoskeletal and Rheumatologic Presentations96▾

Dermatology Presentations23▾

Environmental and Exposure Presentations27▾

Hematologic and Oncologic Presentations36▾

Pediatric-Specific Presentations19▾

Bronchiolitis Croup Ductal-dependent congenital heart disease Emergency delivery Febrile seizure Hypercyanotic (tet) spell Inborn error of metabolism Intussusception Kawasaki disease Necrotizing enterocolitis Neonatal jaundice Neonatal resuscitation Nursemaid's elbow Pediatric DKA and cerebral edema Pediatric fever 0 to 28 days Pediatric fever 29 to 60 days Pediatric fever 61 to 90 days Pediatric septic shock Pyloric stenosis

Endocrine and Metabolic Presentations45▾

ENT and Maxillofacial Presentations27▾

Ophthalmologic Presentations19▾

Obstetric Presentations23▾

Systemic and Miscellaneous Presentations17▾

01Approach to the Critical Patient/attcp51

Immediate priorities

›Stabilization priorities

›Airway and breathing

›Apnea

›Respiratory distress

›Circulation

›Shock

›Poor perfusion

›Neurologic risk

›Acute bilirubin encephalopathy concern

›Lethargy

›Hypotonia or hypertonia

›High pitched cry

›Poor feeding

›Fever

›Arching or retrocollis

›Seizure

›Hyperbilirubinemia severity

›Age in hours

›Gestational age category

›Neurotoxicity risk factors

›TSB trajectory

›Rapid rise consistent with hemolysis

›Near exchange threshold

High risk triggers

›Escalation triggers

›Jaundice in first 24 hours

›Hemolysis evaluation priority

02History/hx54

Core history elements

›Key history

›Age in hours at onset

›Jaundice before 24 hours

›Peak timing

›Gestational age and birth weight

›Late preterm 35 to 37 weeks

›Small for gestational age

›Feeding history

›Latch quality

›Frequency

›Milk transfer concern

›Supplementation

›Output history

›Wet diapers count

›Stool frequency and color

›Weight change

›Percent weight loss from birth

›Dehydration concern

›Maternal and infant blood groups

›ABO incompatibility risk

›Rh status

›Maternal antibodies history

›Family history

›G6PD deficiency

›Prior sibling requiring phototherapy

›Prior sibling exchange transfusion

›Birth trauma

03Physical Exam/exam40

Focused exam

›Exam targets

›General appearance

›Toxic appearance

›Lethargy

›Irritability

›Vital signs

›Fever

›Hypothermia

›Tachycardia

›Hypotension

›Hydration status

›Mucous membranes

›Skin turgor

›Fontanelle

›Skin findings

›Jaundice extent

›Bruising

›Cephalohematoma

›Petechiae

›Neurologic tone and behavior

›Hypotonia

›Hypertonia

›Arching

›High pitched cry

›Suck quality

›Abdominal exam

›Hepatomegaly

04Differential Diagnosis/ddx36

Unconjugated hyperbilirubinemia

›Causes of unconjugated hyperbilirubinemia

›Physiologic jaundice

›Increased bilirubin production

›Immature conjugation

›Hemolysis

›ABO incompatibility ICD-10 P55.1

›Rh isoimmunization ICD-10 P56.0

›Other red cell antibodies ICD-10 P55.8

›G6PD deficiency

›Hereditary spherocytosis

›Increased bilirubin load

›Cephalohematoma ICD-10 P12.0

›Extensive bruising ICD-10 P58.0

›Polycythemia ICD-10 P61.1

›Decreased intake

›Breastfeeding jaundice

›Dehydration and weight loss

›Endocrine or metabolic

›Congenital hypothyroidism

›Crigler Najjar syndrome

›Gilbert syndrome

›Infection

›Sepsis ICD-10 P36.x

›Urinary tract infection

Conjugated hyperbilirubinemia

›Causes of conjugated hyperbilirubinemia

›Biliary obstruction

05Laboratory Tests/lt56

Bilirubin and hemolysis panel

›Core labs

›Total serum bilirubin

›Decision standard for treatment thresholds

›Repeat interval based on proximity to threshold

›Direct or conjugated bilirubin

›Indications

›Prolonged jaundice

›Ill appearance

›Pale stools

›Dark urine

›Infant blood type and DAT

›Isoimmune hemolysis detection

›DAT negative hemolysis possibility

›Maternal blood type and antibody screen

›Rh and minor antigen risk

›Hemoglobin or hematocrit

›Hemolysis severity assessment

›Anemia detection

›Reticulocyte count

›Hemolysis marker

›Bone marrow response

›Peripheral smear

›Spherocytes

›Fragmentation

Additional labs by scenario

›Targeted labs

›G6PD level

06Diagnostic Tests/dt41

Scoring Systems

›Risk stratification tools

›Hour specific bilirubin nomograms

›Predischarge TSB or TcB plotted by age in hours

›Risk zones for subsequent significant hyperbilirubinemia

›Delta to treatment threshold approach

›TSB difference from phototherapy threshold

›Follow-up timing based on proximity

›Neurotoxicity risk factor assessment

›Gestational age under 38 weeks

›Isoimmune hemolysis

›G6PD deficiency

›Sepsis

›Clinical instability

›Low albumin

MRI

›Neuroimaging

›Indications

›Suspected chronic bilirubin encephalopathy

›Persistent abnormal tone or movement disorder after neonatal period

›Typical findings

›Bilateral globus pallidus signal abnormalities

›Subthalamic nucleus involvement

›Limitations

›Early MRI false positives possible

›Imaging not required for acute treatment decisions

›CT role

07Disposition/dispo23

Site of care

›Disposition decisions

›NICU level care

›Exchange transfusion indicated

›Acute bilirubin encephalopathy signs

›Rapid rise with hemolysis and near exchange threshold

›Inpatient ward

›Phototherapy requirement

›Significant feeding support needs

›Sepsis evaluation pending

›Outpatient management

›Below phototherapy threshold

›Well appearing

›Reliable follow-up within recommended interval

Follow-up timing

›Follow-up planning

›Timing based on age and bilirubin proximity to threshold

›Closer follow-up when TSB near phototherapy threshold

›Earlier repeat bilirubin when rapid rise suspected

›Feeding follow-up

›Lactation support appointment

›Weight check within 24 to 48 hours when weight loss concern

›Prolonged jaundice follow-up

›Direct bilirubin testing pathway

›Stool color monitoring pathway

08Treatment/t66

Phototherapy

›Phototherapy strategy

›Intensive phototherapy criteria

›TSB at or above treatment threshold for age and risk category

›Hemolysis with rapid rise

›Delivery optimization

›Maximal skin exposure

›High irradiance device

›Minimized time off lights

›Monitoring and response

›TSB reassessment interval

›Short intervals when near exchange threshold

›Longer intervals when falling and far from threshold

›Expected decline pattern

›Early decline within hours suggests adequate irradiance

›Poor response suggests hemolysis or inadequate intensity

›Supportive care during phototherapy

›Maintain normothermia

›Hydration and feeding support

›Eye protection and positioning

Exchange transfusion

›Exchange transfusion pathway

›Indications

›TSB at or above exchange threshold for age and risk category

›Acute bilirubin encephalopathy signs regardless of level

›Bridge measures while preparing

›Intensive phototherapy continued

›IV access readiness

09Special Populations/sp29

Pregnancy

›Maternal factors affecting neonatal risk

›Maternal blood group and antibodies

›Rh negative with sensitization risk

›ABO incompatibility risk when mother O

›Diabetes in pregnancy

›Polycythemia risk

›Prematurity risk

›Delivery factors

›Assisted delivery with bruising risk

›Delayed cord clamping and bilirubin load context

Geriatric

›Applicability

›Not applicable

›Neonatal specific condition

›No geriatric modifications

›Systems note

›Ensure neonatal pathway selection in order sets

›Avoid adult jaundice protocols

Pediatrics

›Neonatal specific considerations

›Gestational age groups

›35 to 37 weeks higher neurotoxicity risk

›Under 35 weeks separate thresholds and NICU protocols

›Neurotoxicity risk factors

›Sepsis

›Hemolysis

›Clinical instability

10Background/b37

Epidemiology

›Frequency and burden

›Common neonatal condition

›Physiologic jaundice in many newborns

›Subset requiring phototherapy

›Peak timing

›Term peak commonly day 3 to 5

›Later peak in breast milk jaundice

›Major risk contributors

›Prematurity

›Hemolysis

›Exclusive breastfeeding with suboptimal intake

›Bruising and cephalohematoma

Pathophysiology

›Mechanisms

›Unconjugated bilirubin production

›High neonatal red cell turnover

›Shorter red cell lifespan

›Hepatic uptake and conjugation limits

›Immature UGT1A1 activity

›Reduced clearance early life

›Enterohepatic circulation

›Increased beta glucuronidase activity

›Delayed stooling increases reabsorption

›Neurotoxicity pathway

›Unbound bilirubin crossing blood brain barrier

›Basal ganglia and brainstem nuclei vulnerability

11Patient Discharge Instructions/pdi23

copy discharge instructions

›Discharge instructions

›Feeding and hydration

›Feed at least 8 to 12 times per 24 hours if breastfeeding

›Monitor wet diapers

›Monitor stool frequency and color

›Follow-up plan

›Repeat bilirubin test at scheduled time

›Weight check appointment

›Lactation support contact

›Home safety with jaundice

›Avoid sun exposure as treatment substitute

›Maintain normal room temperature

›Return now warning signs

›Poor feeding

›Hard to wake or unusual sleepiness

›High pitched cry

›Stiffness or arching

›Fever

›Breathing problems

›Fewer wet diapers

›Pale or white stools

›Dark urine

›Jaundice spreading to legs or deepening quickly

12References/r48

Clinical guidelines and key sources

›Core references

›AAP Clinical Practice Guideline Revision 2022

›Title

›Management of Hyperbilirubinemia in the Newborn Infant 35 or More Weeks of Gestation

›Journal

›Pediatrics 2022;150(3):e2022058859

›DOI

›10.1542/peds.2022-058859

›Link

›https://publications.aap.org/pediatrics/article/150/3/e2022058859/

›Canadian Paediatric Society position statement 2025

›Title

›Guidelines for detection and management of hyperbilirubinemia in term and late preterm newborns 35 or more weeks gestation

›Date

›March 18, 2025

›Link

›https://cps.ca/en/documents/position/hyperbilirubinemia-newborns

›NICE Clinical Guideline CG98

›Title

›Jaundice in newborn babies under 28 days

›Link

›https://www.nice.org.uk/guidance/cg98

›Bhutani et al 1999 predischarge nomogram study

›Journal

›Pediatrics 1999

›PubMed

›9917432

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Reviewed by SymptomDx Medical Team · Last reviewed August 18, 2026

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