Neonatal jaundice
Neonatal hyperbilirubinemia is among the most common clinical conditions encountered in neonatology. Up to 80% of newborns develop some degree of jaundice in the first days of life. Although hyperbilirubinemia is benign and transient in most cases, markedly elevated bilirubin levels may lead to acute bilirubin encephalopathy and kernicterus, resulting in permanent neurologic injury. Therefore, early identification of newborns at risk for significant hyperbilirubinemia and prompt initiation of appropriate treatment are essential. In this algorithm, you will be introduced to three model cases of neonatal jaundice. Based on these cases, the approach to the differential diagnosis of neonatal hyperbilirubinemia and an overview of the main therapeutic strategies for individual clinical conditions will be presented.
Review
Jaundice is one of the most common diagnoses in neonatology and is encountered on an almost daily basis. The case studies provide excellent coverage of both the most common physiological jaundice and rarer but serious, potentially life-threatening conditions. The differential diagnosis is presented in a clear and logical manner and closely reflects the clinical approaches currently used in practice. Each step of the diagnostic algorithm is explained clearly. This is an excellent educational tool and a valuable resource for anyone preparing for their first on-call shift.
Sources
STANÍKOVÁ, A. and J. MALÝ, 2022. Novorozenecká hyperbilirubinemie – doporučený postup České neonatologické společnosti. ČNeoS [online]. ČNeoS [cited 2025-12-23]. Available from: https://cneos.cz/wp-content/uploads/2022/12/Hyperbilirubinemie_2022.pdf
KEMPER, Alex R., Thomas B. NEWMAN, Jonathan L. SLAUGHTER, et al., 2022. Clinical Practice Guideline Revision: Management of Hyperbilirubinemia in the Newborn Infant 35 or More Weeks of Gestation. Pediatrics [online]. American Academy of Pediatrics (AAP), 2022-08-05, 150(3) [cited 2025-12-23]. ISSN 0031-4005. Available from: doi:10.1542/peds.2022-058859
ŠUMNÍK, Zdeněk, Petr JABANDŽIEV and Jan JANOTA, [2025]. Pediatrie. Prague: Galén. ISBN 978-807-4927-775.
NATIONAL INSTITUTE FOR HEALTH AND CARE EXCELLENCE. Jaundice in newborn babies under 28 days. Clinical guideline CG98 [online]. London: NICE, 2010. Updated 31 October 2023 [cited 2026-02-04]. Available from: https://www.nice.org.uk/guidance/cg98
Learning targets
2. The solver is familiar with the basic diagnostic evaluation and laboratory assessment of newborns with hyperbilirubinemia.
3. The solver is familiar with the therapeutic management of unconjugated hyperbilirubinemia in the newborn.
Key points
2. Management of unconjugated hyperbilirubinemia is guided by nomograms that consider total serum bilirubin, postnatal age, gestational age, and risk factors.
3. The main treatment options for unconjugated neonatal hyperbilirubinemia are phototherapy and exchange transfusion.
4. Conjugated hyperbilirubinemia is always pathologic and requires a broad differential diagnosis to determine the underlying cause and guide therapy.
