 Is a yellowish discoloration of the sclera and the skin of a newborn

baby.
 It is a common condition particularly in babies born before 38 weeks
of gestation (preterm babies) and some breast-fed babies. Neonatal
jaundice usually occurs because a baby’s liver isn’t mature enough to
get rid of bilirubin in the bloodstream.
 When jaundice occurs in a healthy baby, it is considered physiological
jaundice. Most babies have a degree of jaundice after birth because
their liver is unable to process bilirubin.
 With physiological jaundice, newborns are often unable to process the
bilirubin in their system after birth. When high levels of bilirubin
accumulate, a yellowing effect can occur.
 Physiological jaundice generally clears on its own. However, in more
severe cases, phototherapy may be recommended to help break down
the bilirubin.
 Pathological jaundice can occur in children and adults and is the result
of jaundice that presents a health risk because of its degree or cause.
 Underlying causes of pathological jaundice include: blood
incompatibilities , blood diseases, infections or medications.
 In pathologic jaundice, the underlying causes of the jaundice is treated
and once corrected, the jaundice is clear.
 Physiological Pathological

Onset 2nd to 3rd day of life At any time

Level of Bilirubin Usually lower Usually higher

Type of Bilirubin Unconjugated Any

Rate of increase Slow increase May be faster

Duration Shorter May be longer

(7-10 days in the term & 14 days in the preterm)

Physical Exam & Lab. Tests Normal, healthy infant abnormal

 Excess bilirubin (hyperbilirubinemia)
 Internal bleeding (hemorrhage)
 A blood infection (sepsis)
 Other viral or bacterial infections
 An incompatibility between the mother’s blood and the baby’s blood.
 A liver malfunction
 An enzyme deficiency
 An abnormality in your baby’s blood that cause them to break.
 Underactive thyroid gland (hypothyroidism)
 Low oxygen levels (hypoxia)
 An inflammation of the liver (hepatitis)
 Yellowish discoloration of the skin and the sclera. Typically starts at the
head, and spreads to the chest, stomach, arms and legs.
 The baby seems listless or sick or is difficult to awaken.
 The baby isn’t gaining weight.
 Pale stools – breast-fed babies should have greenish-yellow stools,
while those of bottle fed babies should be a greenish-mustard color.
 Poor sucking or feeding.
 Dark urine – a newborn’s urine should be colorless.
 The discoloration lasts more than 3 weeks.
 A physical examination.
 A laboratory test of a sample of the baby’s blood.
 A skin test with a device called “transcutaneous bilirubinometer”,
which measures the reflection of a special light shone through the
skin.
To evaluate degree of compromise:
 Review laboratory studies. (Bilirubin and albumin levels, hemoglobin
and hematocrit, reticulocyte count)
 Calculate plasma bilirubin-albumin binding capacity. (Aids in
determining risk of kernicterus and treatment needs.)
 Assess infant for progression of signs and behavioral changes
associated with bilirubin toxicity.
 Evaluate appearance of skin and urine, noting brownish-black color.
To correct hyperbilirubinemia and prevent associated complications:
 Keep infant warm and dry; monitor skin and core temperature
frequently.
 Initiate early oral feedings within 4 to 6 hours following birth especially
if infant is to breastfed.
 Encourage frequent breastfeeding – 8 to 12 times per day. ; Assist
mother with pumping of breasts as needed to maintain milk
production.