management of neonatal jaundice

Last reviewed 08/2023

Management is as follows:

• diagnosis and correction of any underlying abnormality is important
• fluid and caloric intake will prevent worsening jaundice
• unconjugated hyperbilirubinaemia may be treated with phototherapy or with exchange transfusion
• conjugated hyperbilirubinaemia due to obstruction would be treated with the appropriate management for the underlying condition. Phototherapy or exchange transfusion may be required depedning on level of hyperbilirubinaemia
• management options for hyperbilirubinaemia have been stated by NICE (1):
  • monitoring, or,
  • phototherapy, or,
  • exchange transfusion
  • NICE have issued guidance as to the levels of raised bilirubin and age of the neonate when each management strategy is indicated:

    • For treatment threshold graphs for phototherapy and exchange transfusion for babies with gestational ages from 23 weeks to 38 weeks or more

      • Treatment threshold graphs ...click here
        
        

      Consensus-based bilirubin thresholds for management of babies 38 weeks or more gestational age with hyperbilirubinaemia

      Table 1: Bilirubin levels when a repeat bilirubin measurement in 6-12 hours is indicated

      Age (hours)	Bilirubin measurement (micromol/litre)
      0	-
      6	>100
      12	>100
      18	>100
      24	>100
      30	>112
      36	>125
      42	>137
      48	>150
      54	>162
      60	>175
      66	>187
      72	>200
      78	-
      84	-
      90	-
      96+	-

      Table 2: Bilirubin levels when a clinician should consider phototherapy and repeat bilirubin measurement in 6 hours

      Age (hours)	Bilirubin measurement (micromol/litre)
      0	-
      6	> 112
      12	>125
      18	>137
      24	>150
      30	>162
      36	>175
      42	>187
      48	>200
      54	>212
      60	>225
      66	>237
      72	>250
      78	>262
      84	>275
      90	>287
      96+	>300

      Table 3: Bilirubin levels when starting phototherapy is indicated

      Age (hours)	Bilirubin measurement (micromol/litre)
      0	>100
      6	> 125
      12	> 150
      18	> 175
      24	> 200
      30	> 212
      36	> 225
      42	> 237
      48	> 250
      54	> 262
      60	> 275
      66	> 287
      72	> 300
      78	> 312
      84	> 325
      90	> 337
      96+	> 350

      Table 4: Perform an exchange transfusion unless the bilirubin level falls below threshold while the treatment is being prepared

      Age (hours)	Bilirubin measurement (micromol/litre)
      0	> 100
      6	> 150
      12	> 200
      18	> 250
      24	> 300
      30	> 350
      36	> 400
      42	> 450
      48	> 450
      54	> 450
      60	> 450
      66	> 450
      72	> 450
      78	> 450
      84	> 450
      90	> 450
      96+	> 450

       

Reference:

• 1) NICE (May 2010). Neonatal Jaundice