New born Jaundice

Prepared by: Dr. Abla Neyazi


A condition of yellowish skin color during the newborn period due to the elevation of serum bilirubin

more than 1.5 mg(normal at birth)

Metabolism of bilirubin:

Break down of RBC’s releases Hb which in turn disintegrates into a part called Haem containing the iron part, and Globulin the protien partm. Then Haem gets converted into bilirubin which is called unconjugated or indirect bilirubin which circulates in the blood loosely connected to the globulin. When the blood reaches the liver the bilirubin gets metabolised by series of enzymes and gets coverted to conjugated or direct bilirubin, which gets excreted via the bile duct and thrown into gut which is excreted with the stool in the form of stercobilin which colors the stool brown, or stored in the gall bladder


Pathogenic :

Non-physiologic, prolonged, or pathogenic jaundice in the newborn may have many causes. Risk factors for a greater degree of jaundice include prematurity and different races. Other conditions may cause pathologic (disease-related) jaundice in the newborn and should be ruled out if the jaundice persists, or if other symptoms are present. These disorders include:

  1. biliary atresia
  2. ABO incompatibility (similar to a transfusion reaction, caused when
  3. fetal and maternal blood mingle before birth)
  4. Rh incompatibility (Anti-Rh antibodies)
  5. galactosemia (see galactosemia screen)
  6. cephalhematoma
  7. polycythemia
  8. glucose-6-phosphate dehydrogenase deficiency
  9. neonatal sepsis
  10. congenital cytomegalovirus infection (CMV)
  11. congenital toxoplasmosis
  12. congenital syphilis
  13. congenital herpes
  14. congenital rubella
  15. late pregnancy administration of sulfa drugs to the mother
  16. Crigler-Najjar syndrome
  17. spherocytosis (congenital hemolytic anemia)
  18. cystic fibrosis
  19. breastmilk jaundice
  20. pyruvate kinase deficiency
  21. thalassemia
  22. Gilbert's syndrome
  23. congenital hypothyroidism
  24. Lucey-Driscol syndrome
  25. Gaucher's disease
  26. Niemann-Pick disease


  1. Early onset 2nd to 5th day (breast feeding jaundice)
  2. Late onset 5th to 10 days (breast milk jaundice)

Breast feeding jaundice:


  1. It appears in the 1st week of life- 2nd to 5th day it peaks on day 4th
  2. Bilirubin level rarely exceeds 17mg\dl
  3. It lasts for 1-2 wks
  4. Etiology infrequent breast feeding- because it increases entero-hepatic circulation
  5. Management:

  • frequent feedings day and night 8-12 times/day
  • avoid water or glucose water
  • unable to suckle- express milk and feed to the baby

    Breast milk jaundice:


  1. It appears towards the end of 1st wk of life-usually 5th to 10 days of age-peak 5th to 15th day
  2. Duration 3wks to 3 months
  3. Bilirubin level may exceed 20mg/dl
  4. Etiology: still unknown may be due to:
  5. 1-Increased entero hepatic circulation or

    2- Presence of certain substance in the breast milk

  6. Currently it is a diagnosis of exclusion
  7. Management:

  • If bilirubin > 20mg/dl brief interruption of breast feeding (12-48 hours )
  • Photo therapy
  • Exchange transfusion – rarely required