Jaundice beginning in the first 24 h after birth is pathological. It is usually unconjugated and the commonest causes are haemolytic anaemia or infection. Jaundice beginning on days 2-5 is commonly physiological, but unconjugated hyperbilirubinaemia may have many causes including haemolytic disease, ABO incompatability and G-6-PD deficiency.
Guidelines for the management of neonatal jaundice are derived from the belief that bilirubin levels greater than 340 mmol/l in term infants can cause deafness and kernicterus. This is based on data established when ker-nicterus due to severe rhesus disease was common but it has not been demonstrated that 340 mmol/l is the critical level for nervous system injury in other conditions. It is generally believed that in preterm infants critical levels are lower than this, especially if the infants have intercurrent illness, while at term higher concentrations may be tolerated without neurological deficit provided the infant does not have additional pathology such as infection or acido-sis. Many authorities now advocate a more relaxed view of neonatal jaundice in a well, term infant, but haemolytic jaundice and jaundice in the sick or preterm infant should always be treated aggressively. Failure to control bilirubin levels by phototherapy should lead to urgent exchange transfusion.
Conjugated hyperbilirubinaemia signifies liver disease and requires urgent specialist investigation. These infants may be at risk of complications such as significant bleeding and neurological damage.
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