Learning objectives

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

More than 50% of normal newborns and 80% of preterm infants have some jaundice. Jaundice may be normal or abnormal and the healthcare worker needs to be familiar with its management.

Physiological Pathological Prolonged/ pathological

Evaluation for aetiology on history

Birth weight, gestation and postnatal age Consider jaundice of prematurity<

Evaluation for aetiology on examination

Prematurity Jaundice of prematurity
Temperature instability:
CNS signs e.g. lethargy
Cephalohaematoma or significant bruising This can lead to jaundice
Petechiae, hepato-splenomegaly Congenital infection

Assessment of severity of jaundice

Assess the level of jaundice clinically: blanching reveals the underlying colour. Neonatal jaundice first becomes visible in 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. If possible confirm with a transcutaneous bilirubinometer or a serum bilirubin

Also assess for features of acute bilirubin encephalopathy, also called kernicterus and for dehydration which is commonly associated.
The bilirubinometer is useful to measure transcutaneous serum bilirubin but not widely available. It should be used on the chest and the forehead (which is not directly exposed to the phototherapy) and whichever value is highest should be used.


Infection screen – infection must be excluded in any baby who is unwell and jaundiced or has risk factors for sepsis do LP, blood culture, urinalysis.

Blood grouping and Rh status (both baby and mother), Coombs test if available, PCV, VDRL


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

When to start phototherapy for jaundice: wall chart for phototherapy

Whilst on phototherapy:

  • Baby’s eyes should be covered with gauze pad.
  • Check bilirubin level daily if possible.
  • Turn baby 2 hourly.
  • Monitor signs of dehydration.
  • Ensure the baby is feeding well – top up with EBM via cup or NGT if necessary.
  • Encourage mother- child bonding,
  • When to stop phototherapy

    Continue phototherapy until the serum bilirubin level is lower than the threshold range or until the jaundice is limited to area 1 in preterm infants and areas 1+2 in term infants. wall chart for phototherapy

    Prolonged Jaundice

    Jaundice lasting longer than 14 days in term or 21 days in preterm infants is abnormally prolonged.

    If the baby’s stools are pale or the urine is dark, refer the baby to a central hospital for further management including doing both direct and indirect serum bilirubin level, ultrasound and thyroid function tests