Neonatal Jaundice

Abstract

Jaundice in the newborn has presented a diagnostic challenge to clinicians for millennia. Because virtually every newborn infant has an elevated serum bilirubin in comparison with the normal adult and more than 50% are visibly jaundiced during the first week of life, the physician's first challenge is to differentiate pathology from variations within the normal range. Today, clinicians are faced with critical therapeutic decisions as well; treatment should be instituted only when benefit will accrue. During the past several years, clinical experts and scholars have reconsidered the risks and possible benefits of bilirubin in the newborn, have altered indications for diagnostic procedures, and have suggested new criteria for therapy. In addition, the relationship between breastfeeding and neonatal jaundice has been clarified. These major new concepts have changed the management of jaundice in the newborn significantly, particularly in the healthy term infant. This review examines these new concepts, places them in a clinical perspective, and provides guidelines for management based on a synthesis of expert opinions and the recently published practice guidelines of the American Academy of Pediatrics. ¹

Definitions

The term neonatal jaundice designates all situations in the newborn infant in which the serum bilirubin is sufficiently elevated to cause at least minimally visible yellowing of the skin, ocular sclerae, or both.