GPAtlas🧭 When to suspect
Neonatal jaundice is yellow discolouration of the skin and sclerae caused by a raised bilirubin, and it affects roughly 60% of term and 80% of preterm babies in the first week of life.
Most is physiological: it appears after 24 hours (typically day 2–3), peaks around day 3–5, and fades by day 10–14 as the immature liver matures.
The whole task in primary care is to sift this benign majority from the dangerous minority – chiefly:
• Isoimmune haemolysis (Rhesus or ABO incompatibility, together termed haemolytic disease of the fetus and newborn, HDFN)
• Glucose-6-phosphate dehydrogenase (G6PD) deficiency
• Sepsis
• Time-critical biliary atresia
Three questions do almost all the work:
• When did it start? Jaundice in the first 24 hours is pathological until proven otherwise.
• How long has it lasted? Jaundice that is prolonged (beyond 14 days at term, 21 days if preterm) must be investigated.
• What colour are the stools and urine? Pale stools with dark urine point to cholestasis at any age.
Risk of significant hyperbilirubinaemia is higher with:
• Gestation under 38 weeks
• A previous sibling who needed phototherapy
• Exclusive breastfeeding
• Visible jaundice in the first 24 hours
| Timing of jaundice | Likely significance | Primary-care action |
|---|---|---|
| Within first 24 hours | Always pathological – haemolysis or sepsis | • Same-day paediatric review • Urgent serum bilirubin |
| Day 2 to day 14 (term) | Usually physiological | • Visual check at every contact • Measure bilirubin if visibly jaundiced |
| > 14 days term or > 21 days preterm (prolonged) | Often breast-milk jaundice, but exclude cholestasis | Split bilirubin + check stool/urine colour |
| Pale stools + dark urine (any age) | Conjugated (cholestatic) jaundice – never physiological | Urgent paediatric referral |
Source: NICE CG98
🔒 Sign up free to read the full topic
You're viewing a free preview. Create a free account to unlock the rest.
Sign up free →Sample topics are open to everyone in the Free Sample Bundle.