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. A resurgence of kernicterus and not infrequent delays in the diagnosis of hepatic, metabolic, endocrine, and genetic causes serve as reminders that current management of neonatal jaundice needs refinement. Phototherapy remains the mainstay of treatment of significant unconjugated hyperbilirubinaemia, and its optimal use should keep the level of jaundice below the threshold for exchange blood transfusion. In cases of isoimmune 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. The importance of identifying conjugated hyperbilirubinaemia at an early stage cannot be overstated.