Neonatal Jaundice and Bilirubin Management
Neonatal jaundice - yellowing of a newborn's skin and eyes from elevated bilirubin - is the single most common reason a newborn is readmitted to hospital after discharge. Most jaundice is physiological and harmless, resolving without treatment. The clinical imperative is identifying the patterns that require bilirubin measurement and, where the level crosses the age-specific threshold, phototherapy - because kernicterus, the bilirubin-related brain injury that produces lifelong disability, is entirely preventable when jaundice is recognised and treated in time. Dr. Rajendra Pathak, MBBS, MD Paediatrics, Founder-Director of Vatsalya Children's Hospital, Varanasi, with 40 years of paediatric and neonatal clinical experience, evaluates and manages neonatal jaundice using both serum bilirubin sampling and transcutaneous bilirubinometry, plotting every result against age-specific bilirubin nomograms before any treatment decision is made. Physiological jaundice - appearing after 24 hours, peaking on days three to five, clearing by the end of the second week - requires monitoring but usually not treatment. Patterns requiring prompt assessment include: jaundice appearing within 24 hours of birth (always pathological, always investigate), jaundice spreading rapidly below the chest to the abdomen, thighs, palms, or soles, jaundice persisting beyond two weeks in a term baby, and jaundice with pale chalky stools and dark urine suggesting biliary disease. Phototherapy, using blue-spectrum light that photoisomerises bilirubin in the skin to a water-soluble form excreted in urine and stool, is the standard treatment when the nomogram threshold is crossed. Most jaundiced newborns treated with phototherapy show bilirubin fall within 24 to 48 hours. Sunlight is not a substitute for phototherapy and carries risk of sunburn and overheating in newborns.