Approach to Neonatal

Jaundice
Anas Obeid
● History
● Physical Examination
● Differential Diagnosis
● Investigations
History

● History of present illness

● Prenatal history
● Family history
 History of present illness

● Onset and progression of jaundiced skin

● Feeding: breast milk or formula? frequency?
● Current weight compared to birth weight. Gaining weight appropriately?
● Number of wet diapers per day? (Indicator of hydration status)
● Consistency and colour of stool and urine color ?
● Infections or fever?
● Medications? (newborn or mother)
● General activity: irritable? lethargic?
Perinatal History Family History:
● Maternal blood group ● Previous siblings with neonatal
jaundice
● Maternal illnesses or infections
● Other family members with jaundice
● Results of antenatal screening tests
● Anemia or blood disorders
● Maternal medicine or drug intake
● Splenectomy
● Delayed cord clamping (could indicate
● Bile stones or gallbladder removal
polycythemia)
● Birth trauma with bruising
● Results of newborn screening tests
● Gestational Age
 ● General
● Vitals

Physical ●
●
Growth Parameters
HEENT
examination ●
●
Cardiovascular
Respiratory
● Abdomen
● Neurolgical
Investigations
Hemolytic work-up
● Septic work-up if clinically
● Serum bilirubin: conjugated and
indicated
unconjugated ● G6PD screen (especially if male and
● CBC (mainly for Hb and Hct but
of Asian or Middle Eastern
also WBC as a non-specific marker ethnicity)
of infection) ● Other red cell enzyme studies if
● Peripheral blood smear (for RBC
hemolysis remains undefined
morphology) ● Osmotic fragility
● Maternal and infant ABO and Rh
status
● Direct Coomb’s test
● Liver enzymes and function
● Liver scan (HIDA scan)
● liver biopsy
● Abdominal US with doppler evaluation of the hepatic vessels
● Metabolic screen for inborn errors of metabolism.
● TORCH screen.