For general practitioners: The problem of jaundice in the newborn

Conclusion

It may be inferred from the above discussion that most of the conditions causing neonatal jaundice need special investigations for diagnosis and therapy. It may not be possible for a practitioner to undertake all these. A newborn with jaundice showing one of the following features needs detailed investigations and should be referred to a proper hosptial for further evaluation.

• 1. Jaundice appearing in the first twenty-four hours of life in full-term infants and forty-eight hours in the premature. The commonest cause of such jaundice is hemolytic disease. The other conditions that may be responsible are hepatitis, sepsis, toxoplasmosis and cytomegalic inclusion disease.

• 2. Rapidly increasing jaundice. This indicates excessive hemolysis or release of bilirubin from a hematoma.

• 3. A high level of serum bilirubin. Arbitrary levels for this are more than 12 mg% in full term and more than 15 mg% in premature babies.

• 4. Prolonged jaundice (beyond 2 weeks). It may be seen in cretins, infants of diabetic mothers, cases of pyloric stenosis, etc.

• 5. Direct bilirubinemia. The presence of conjugated bilirubin more than 1 to 2 mg% indicates an additional defect of excretion of bilirubin which may be the result of hepatocellular damage or obstruction. This finding can be confirmed by detecting bilirubin in the urine.