Ictère à bilirubine non conjuguée du nouveau-né après sortie de maternité : de la physiopathologie à la pratique

Jaundice due to unconjugated bilirubin is an everyday condition in the neonatal period because it results from the adaptation of bilirubin metabolism at this time of life. Hyperbilirubinemia has a potential neurotoxicity and although it resolves most of the time spontaneously, it can lead to acute and sometimes chronic encephalopathy. This condition is called kernicterus and induces irreversible neurological sequelae. This rare complication is still reported in all countries throughout the world and its prevention is possible as critical points of failure in jaundice management are identified. Jaundice is the major issue of the first days of life until and after maternity unit discharge (major cause of readmission within the 15 first days of life). Therefore, numerous countries have written national practical guidelines for the management of neonatal jaundice and the more recent ones were written in 2017 by the Société française de néonatologie. The French guidelines follow a pathophysiological approach, as does the work presented here. In the first part, the practical consequences of this pathophysiological approach of the symptom called jaundice are developed. Then an assessment of the jaundiced newborn is proposed, based on four key points: history, risk factors of severe hyperbilirubinemia, clinical assessment with specific attention to weight gain and quality of feeding, and then jaundice quantification. This should allow the pediatrician to manage a jaundiced newborn safely while respecting the ongoing setting of breastfeeding and family bonding after maternity discharge.