Jaundice and Phototherapy (Chapter 13)

Learning Objectives

After completion of this chapter the participant should be able to:


More than 50% of normal newborns and 80% of preterm infants become jaundiced and the healthcare worker needs to be familiar with diagnosis and management. The number of newborns requiring treatment for jaundice can be reduced by keeping the baby with the mother allowing for more frequent breastfeeding and increasing bilirubin excretion in the stools.

Physiological Pathological Prolonged/ pathological
Appears after 48 hours of
life. Maximum by 4th and
7th day. Generally,
disappears without any
treatment but some NYI
will require phototherapy.
Starting on the first day of
life; may have fever. Deep
jaundice: palms and
Jaundice lasting for
longer than 14 days in
term infants and 21 days
in preterm infants.
Possible causes
Neonatal sepsis
Congenital infection
Possible causes
Neonatal hepatitis
Biliary atresia (pale stool
and dark yellow urine)

Evaluation for Aetiology in History

History Diagnosis
Birth weight
Postnatal age
Consider jaundice of prematurity
Sleepy, lethargy
Poor feeding
Change in cry –
high-pitched or reduced crying
Mother: urinary tract infection, foul smelling
amniotic fluid, maternal fever
Neonatal sepsis often causes jaundice
Birth asphyxia (5 min Apgar of 7 or less) Birth asphyxia is often associated with jaundice
Onset of jaundice before 24 hours of age
Family history of significant haemolytic disease
Previous sibling received phototherapy
Failure of phototherapy to reduce the jaundice
Incompatibility between mothers and
baby’s blood, may cause severe
haemoglobinopathy. (ABO incompatibility
and Rhesus disease)

Evaluation for Aetiology on Examination

Examination Diagnosis
Prematurity Jaundice of prematurity
Temperature instability
CNS signs e.g. lethargy
Possible meningitis or sepsis
Cephalohaematoma or
significant bruising
Petechiae, hepato-splenomegaly Congenital infection

A baby may have more than one diagnosis.

Assessment of Severity of Jaundice

Assess the level of jaundice clinically: blanching reveals the underlying colour. Neonatal jaundicefirst becomes visible on the face and forehead and gradually becomes visible on the trunk and extremities. This can be used to decide clinically when the baby should be treated. The Kramer scale is used to clinically assess the severity of jaundice depending on the age in days and maturity of the baby. It is not as accurate as a serum bilirubin level or transcutaneous bilirubin reading. If possible, confirm with a transcutaneous bilirubinometer or a serum bilirubin. The bilirubinometer is used to measure serum bilirubin and much more accurate than a clinical assessment.

Also assess for: features of acute bilirubin encephalopathy (kernicterus) , and dehydration with which jaundice is commonly associated.



The treatment for jaundice is phototherapy plus treating the underlying cause, for example sepsis.

Exchange transfusion will be needed if bilirubinlevels raise to a certain levels. See for cut-offs

Prevention of Jaundice

E 11 Phototherapy Lights

Phototherapy should be commenced for neonates with: See Phototherapy lights for more information.

Whilst on phototherapy:

Prolonged Jaundice

Jaundice lasting longer than 14 days in term or 21 days in preterm infants is abnormally prolonged. This may be due to infection, hypothyroidism, hepatitis or biliary atresia.

If the baby’s stools are pale or the urine is dark, refer the baby to a central hospital for further investigation and management including checking both direct and indirect serum bilirubin levels, abdominal ultrasound scan and thyroid function tests. These babies are best diagnosed and treated early for better outcomes