What causes the yellow colouration in jaundice?
Accumulation of bilirubin after red blood cell breakdown.
What gestational age defines a term baby?
37 weeks or more of gestational age.
What does kernicterus clinically indicate?
Acute or chronic bilirubin encephalopathy.
Name one clinical feature of kernicterus.
Cerebral palsy.
What percentage of term babies develop jaundice in the first week?
Approximately 60%.
What percentage of preterm babies develop jaundice in the first week?
Approximately 80%.
Is jaundice usually harmful in newborn babies?
It is harmless in most babies.
Which organization reported jaundice frequency in 2010?
NICE.
Where are ageing or malformed red blood cells removed by phagocytosis?
In the reticuloendothelial system including liver, spleen, and macrophages.
Into which components is haemoglobin separated during breakdown?
Haemoglobin is separated into haem, globin, and iron.
What does haem become during haemoglobin breakdown?
Unconjugated fat-soluble bilirubin.
How is unconjugated bilirubin transported to the liver?
It combines with albumin and is transported in the bloodstream.
What happens to unconjugated bilirubin in the liver?
It is conjugated to water-soluble bilirubin using oxygen, glucose, and enzymes.
What do gut bacteria convert conjugated bilirubin into?
Urobilin, which is excreted in faeces.
What type of globin molecules does fetal haemoglobin contain?
A pair of gamma-globin molecules.
How does fetal haemoglobin's oxygen affinity compare to adult haemoglobin?
It binds oxygen with greater affinity.
How many red blood cells per mm³ does the fetus produce to compensate for poor oxygenation?
Approximately 7 million red blood cells per mm³.
What is the life span of fetal red blood cells at term?
70–80 days.
Why are fetal red blood cells removed after birth?
Because fetal haemoglobin is replaced by adult haemoglobin.
What causes physiological jaundice in newborns?
Short-lived red blood cells, limited albumin binding, a sterile gut, poor peristalsis, and an immature liver increase bilirubin production or reduce its metabolism and excretion.
When does physiological jaundice usually begin in newborns?
Around day 3 after birth.
When does physiological jaundice peak in newborns?
Around day 5 after birth.
How long does physiological jaundice typically last?
Until approximately day 8 after birth.
What percentage of term babies are affected by physiological jaundice?
Approximately 60%.
What percentage of preterm babies are affected by physiological jaundice?
Approximately 80%.
Which guideline reported the prevalence of physiological jaundice in 2010?
NICE, 2010.
What is the maximum bilirubin level in typical physiological jaundice?
Approximately 200–215 μmol/l.
How is jaundice clinically recognised in newborns?
By yellow skin or sclerae, lethargy, poor feeding, pale stools, altered stool frequency, or dark urine.
What does jaundice appearing within 24 hours of life indicate?
It is pathological until proven otherwise and needs immediate paediatric referral.
Which babies are more likely to develop significant hyperbilirubinaemia?
Babies under 38 weeks' gestation, with a sibling needing phototherapy, exclusively breastfed, or jaundiced in first 24 hours.
Who should examine babies for jaundice and when?
All babies should be examined at every opportunity, especially in the first 72 hours.
When should babies with jaundice risk factors receive extra visual examination?
During the first 48 hours by a professional.
Which guideline states jaundice within 24 hours requires referral?
NICE, 2010.
Which guideline identifies risk factors for significant hyperbilirubinaemia?
NICE, 2010.
Which guideline recommends jaundice examination frequency in newborns?
NICE, 2010.
How should visual inspection for jaundice be performed in newborns?
With the naked baby in bright, preferably natural light.
Which areas should be examined during jaundice visual inspection?
The sclerae, gums, and skin by light pressing to assess blanching.
In which direction does jaundice generally progress on a newborn's body?
From the head towards the feet in a caudal direction.
Is visual inspection a reliable predictor of bilirubin severity?
No, visual inspection is a poor predictor of bilirubin severity.
What device is recommended for bilirubin assessment in babies over 24 hours old and 35 weeks gestation?
A transcutaneous bilirubinometer is recommended.
When should serum bilirubin be used after transcutaneous bilirubinometer readings?
For readings above 250 μmol/l and at or above treatment thresholds.
Within what time frame should serum bilirubin be measured in babies over 24 hours old with suspected jaundice?
Urgently within 6 hours.
What is the purpose of measuring serum bilirubin urgently in jaundiced babies?
To determine management of the jaundice.
What causes bilirubin encephalopathy?
Unconjugated bilirubin toxicity in the brain and spinal cord.
When is kernicterus most likely to occur?
When serum bilirubin exceeds 350 μmol/l.
Which factors increase the risk of kernicterus?
Prematurity and other risk factors.
What serum bilirubin level is a risk criterion in babies over 37 weeks?
Above 340 μmol/l.
What rate of bilirubin increase per hour is a risk criterion?
8.5 μmol/l per hour.
Name two clinical features of severe bilirubin toxicity.
High-pitched cry and lethargy.
What is the threshold serum bilirubin level for exchange blood transfusion?
450 μmol/l.
When should jaundice lasting more than 14 days be assessed in babies born at 37 weeks or more?
If jaundice lasts more than 14 days in babies born at 37 weeks or more, assessment is needed.
What assessments are done for prolonged jaundice in newborns?
Assess stool and urine colour, measure conjugated bilirubin, perform blood and urine tests, and confirm metabolic screening.
What is breastmilk jaundice?
It is persistent unconjugated hyperbilirubinaemia into the third and later weeks in healthy breastfed newborns.
Can breastfeeding continue during neonatal jaundice?
Breastfeeding can usually continue during neonatal jaundice.
How does optimal breastfeeding affect breastfeeding jaundice?
Optimal breastfeeding that limits early weight loss reduces breastfeeding jaundice.
How does phototherapy treat bilirubin in the skin?
Phototherapy converts bilirubin into excretable isomers or oxidised forms without conjugation.
How long does most bilirubin conversion take to be excreted after phototherapy?
Most conversion is excreted slowly over 12–21 hours.
What care aspects must be addressed during phototherapy?
Eye protection, temperature regulation, nutrition, fluid management, bowel action, maternal bonding, and reversible bronze skin pigmentation.
Test your knowledge with 26 questions on Physiological Neonatal Jaundice.
1. What does jaundice describe in a newborn?
2. Which finding is characteristic of kernicterus?
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