Jaundice is the yellow colouring of skin and sclera caused by the accumulation of bilirubin in the skin and mucous membranes

Aetiology

• Neonatal jaundice occurs in 60% of term infants and 80% of preterm infants and is caused by hyperbilirubinaemia that is unconjugated (divided into physiological or pathological) or conjugated (always pathological)
• Around 10% of term breastfed babies are jaundiced at 1 month

Pathophysiology

Unconjugated

• Physiological - jaundice in a healthy baby, born at term, is normal and may result from increased RBC breakdown or the immature liver not being able to process high bilirubin concentrations
  • In premature babies, the process of physiological jaundice is exaggerated due to the immature liver - increases risk of complications
• Breast milk jaundice - well baby, resolves between 1.5-4 months
• Haemolysis
• Infection - neonatal sepsis is a common cause of jaundice in the first 24 hours of life
• Inherited causes
• Intestinal obstruction

Conjugated

• Biliary atresia
• TPN
• Hypothyroidism
• Genetic conditions e.g. cystic fibrosis, trisomy 21

Prolonged jaundice

• Jaundice is 'prolonged' when it lasts longer than would be expected in physiological jaundice - over 14 days in a term baby or 21 days in a preterm baby

Clinical features