Neonatal jaundice causes and management

Ruya Althomali, Renad Aloqayli, Basma Alyafi, Ahela Nono, Suhaib Alkhalaf, Abdulaziz Aljomailan, Hesham ALHarbi, Abdulrahman Alqahtani, Hawra Alherz, Moluk Aldebani


80% of healthy neonates present with some degree of hyperbilirubinemia after birth, however, only 5-10% would require therapy to prevent damage or treat the cause of jaundice. Neonatal jaundice can be classified as physiological and pathological and can have several causes such as breast milk feeding, blood group incompatibility, hemolysis, or genetic defects of enzymes in the bilirubin metabolism pathway. We tried to understand the various types of neonatal jaundice, and also focus on its management. We conducted this review using a comprehensive search of MEDLINE, PubMed and EMBASE from January 2001 to March 2017. The following search terms were used: neonatal jaundice, hyperbilirubinemia, ABO incompatibility, neonatal hemolysis, kernicterus, phototherapy, exchange transfusion. Hyperbilirubinemia and jaundice are common issues encountered neonates and infants. Most cases of neonatal hyperbilirubinemia and jaundice are physiological and benign. However, some severe cases may progress to develop severe and permanent long-term complications. Therefore, early diagnosis and management is essential. Neonatal jaundice can be treated using phototherapy, pharmacological agents, intravenous immunoglobulins and exchange transfusion in severe cases.


Neonatal jaundice, Neonatal hyperbilirubinemia, Prematurity, Kernicterus

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Narional Neonatal-Perinatal Databaase. NNPD Network, Indian Council of Medical Research, New Delhi. 2003; Available at: http://www.newbornw Accessed on 3 June 2018.

Chou SC, Palmer RH, Ezhuthachan S, Newman C, Pradell-Boyd B, Maisels MJ, et al. Management of hyperbilirubinemia in newborns: measuring performance by using a benchmarking model. Pediatrics. 2003;112:1264-73.

Huang MJ, Kua KE, Teng HC, Tang KS, Weng HW, Huang CS. Risk factors for severe hyperbilirubinemia in neonates. Pediatr Res. 2004;56:682-9.

Clarkson JE, Cowan JO, Herbison GP. Jaundice in full term healthy neonates--a population study. Aust Paediatr J. 1984;20:303-8.

Dennery PA, Seidman DS, Stevenson DK. Neonatal hyperbilirubinemia. N Engl J Med. 2001;344:581-90.

Gartner LM, Lee KS. Jaundice in the breastfed infant. Clin Perinatol. 1999;26:431-45.

Schneider AP. Breast milk jaundice in the newborn. A real entity. JAMA. 1986;255:3270-74.

Stockman JA. Overview of the state of the art of Rh disease: history, current clinical management, and recent progress. J Pediatr Hematol Oncol. 2001;23:554-62.

Murray NA, Roberts IA. Haemolytic disease of the newborn. Arch Dis Child Fetal Neonatal Ed. 2007;92:83-8.

Kaplan M, Hammerman C. Severe neonatal hyperbilirubinemia. A potential complication of glucose-6-phosphate dehydrogenase deficiency. Clin Perinatol. 1998;25:575-90.

Johnson L, Bhutani VK. Guidelines for management of the jaundiced term and near-term infant. Clin Perinatol. 1998;25:555-74.

Watson D, Rogers JA. A study of six representative methods of plasma bilirubin analysis. J Clin Pathol. 1961;14:271-8.

Bosschaart N, Kok JH, Newsum AM, Ouweneel DM, Mentink R, van Leeuwen TG, et al. Limitations and opportunities of transcutaneous bilirubin measurements. Pediatrics. 2012;129:689-94.

American Academy of Pediatrics Subcommittee on H. Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation. Pediatrics. 2004;114:297-316.

Maisels MJ, Watchko JF, Bhutani VK, Stevenson DK. An approach to the management of hyperbilirubinemia in the preterm infant less than 35 weeks of gestation. J Perinatol. 2012;32:660-4.

Ennever JF. Blue light, green light, white light, more light: treatment of neonatal jaundice. Clin Perinatol. 1990;17:467-81.

Cremer RJ, Perryman PW, Richards DH. Influence of light on the hyperbilirubinaemia of infants. Lancet. 1958;1:1094-7.

Maisels MJ. Phototherapy--traditional and nontraditional. J Perinatol. 2001;21:93-97;104-107.

Shankaran S, Woldt E, Nelson J, Bedard M, Delaney-Black V. Antenatal phenobarbital therapy and neonatal outcome. II:Neurodevelopmental outcome at 36 months. Pediatrics. 1996;97:649-52.

Alpay F, Sarici SU, Okutan V, Erdem G, Ozcan O, Gokcay E. High-dose intravenous immunoglobulin therapy in neonatal immune haemolytic jaundice. Acta Paediatr. 1999;88:216-9.

Vreman HJ, Ekstrand BC, Stevenson DK. Selection of metalloporphyrin heme oxygenase inhibitors based on potency and photoreactivity. Pediatr Res. 1993;33:195-200.

Facchini FP, Mezzacappa MA, Rosa IR, Mezzacappa Filho F, Aranha-Netto A, Marba ST. Follow-up of neonatal jaundice in term and late premature newborns. J Pediatr (Rio J). 2007;83:313-22.