Jaundice is an important problem in the first week of life. It is a cause of concern for the physician and a source of anxiety for the parents. High bilirubin levels may be toxic to the developing central nervous system and may cause neurological impairment even in term newborns. Nearly 60% of term newborn becomes visibly jaundiced in the first week of life. In most cases, it is benign and no intervention is required. Approximately 5-10 % of them have clinically significant hyperbilirubinemia mandating the use of phototherapy.
Jaundice attributable to physiological immaturity of neonates to handle increased bilirubin production. Visible jaundice usually appears between 24-72 hours of age. Total serum bilirubin (TSB) level usually rises in full-term infants to a peak of 6 to 8 mg/dL by 3 days of age and then falls. A rise to 12mg/dL is in the physiologic range. In premature infants, the peak may be 10 to 12 mg/dL on the fifth day of life, possibly rising over 15 mg/dL without any specific abnormality of bilirubin metabolism. Levels under 2mg/dL may not be seen until one month of age in both full term and premature infants. 4 Safe bilirubin levels
in preterms vary according to gestational age.
TSB concentrations have been defined as non-physiologic if concentration exceeds 5 mg/dL on first day of life in term neonate, 10 mg/dL on second day, or 12-13 thereafter. Any TSB elevation exceeding 17 mg/dL should be presumed pathologic and warrants investigation for a cause and possible intervention, such as phototherapy. Appearance of jaundice within 24 hours, peak TSB levels above the expected normal range.