Approach
Background
- Jaundice occurs in ˜ 60% of full term and 80% of pre-term babies within the 1st week of life
- Physiological and breast milk jaundice are the most common causes
- Kernicterus is a rare complication of neonatal unconjugated hyperbilirubinaemia that can lead to major long-term neurological sequelae
- All visibly jaundiced infants presenting to the ED should have their bilirubin levels tested
- The total serum bilirubin (TSB) level can be estimated based on measurements of the transcutaneous bilirubin (TcB)
- These devices measure the yellowness of reflected light transmitted from the skin and use an algorithm to predict the TSB level from the objective measurement of skin colour.
- All patients fit for D/C from the ED needs to be reviewed by a registrar/consultant
In CUH
**Patients ≥14 days, meeting the above **D/C criteria set out in the pathway, can be sent to the PAU the following day at 11.00am for review. Mark the front of the ED folder with a PAU sticker and email cuh.PaedsPauReferral@hse.ie with the patient details and reason for referral in the subject line ie. Neonatal jaundice_ED pathway. The PAU can also be phoned during office hours on the number 22449 (within the hospital).
Types Jaundice / Causes
Type |
Causes |
Early Onset(<24 hours)Pathological |
Sepsis |
Haemolysis
|
|
Peak onset(24hrs - 14 days) |
Physiological jaundice |
| Dehydration/insufficient feeding | |
| Sepsis | |
| Haemolysis | |
| Breastmilk jaundice | |
| Bruising, birth trauma | |
Prolonged /conjugated(>2 weeks) |
Sepsis |
| Haemolysis | |
| Dehydration / insufficient feeding | |
| Breastmilk jaundice | |
| Hypothyroidism | |
Conjugated(at any age point)If conjugated fraction>10% of total bilirubin |
Neonatal hepatitis |
| Extrahepatic obstruction, biliary atresia, choledochal cyst, bile plug | |
| Metabolic | |
| Drugs / parenteral nutrition |
Links/References
- Print version CUH Neonatal Jaundice guideline
- Clinical practice guideline revision: Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation. Kemper AR, Newman TB, Slaughter JL, et al. Pediatrics. 2022;150(3):e2022058859. doi: 10.1542/peds.2022-058859. PMID: 35927462
- The Royal Children's Hospital Melbourne. Available at: https://www.rch.org.au/clinicalguide/guideline_index/jaundice_in_early_infancy/ (Accessed: 09 June 2023)
- Dräger Jaundice Meter JM-105 | Draeger
- http://www.perinatalservicesbc.ca/Documents/Screening/BiliaryAtresia/BA_Stool_Card_Print_20 23Jan.pdf
- NICE Phototherapy Chart
- Screening for hyperbilirubinemia in term and late preterm newborns - UpToDate