Management of neonatal jaundice

Jaundice is the most common clinical sign in neonatal medicine, but only rarely is it associated with bilirubin neurotoxicity or the harbinger of significant underlying disease. Cases of kernicterus, which should be a never event, are still occurring. Delays in the diagnosis of pathological causes of prolonged jaundice, such as biliary atresia are still resulting in life long morbidity. These are salutary reminders that healthcare professionals should never take neonatal jaundice for granted. Phototherapy remains the mainstay of treatment of significant unconjugated hyperbilirubinaemia, and its optimal use will usually prevent the need for exchange blood transfusion. In cases of antibody-mediated haemolysis high-dose immunoglobulin is indicated if the serum bilirubin is continuing to rise despite multiple phototherapy. For babies with prolonged jaundice investigation should be directed towards making a timely diagnosis and avoiding secondary complications.