1. Early (within 24hrs); ALWAYS PATHOLOGICAL
   • Haemolytic cause: Rh isoimmunisation, ABO incompatibility, G6PD deficiency
   • Congenital infection
2. Intermediate (2 -10 days);
   • Physiological (majority); Breastmilk jaundice (inadequate intake); Sepsis; haemolysis; Crigler-Najjar Syndrome; Polycythaemia; bruising
3. Late (>2wks)
   • Conjugated (dark urine/pale stool): bile duct obstruction, biliary atresia, neonatal hepatitis
   • Unconjugated: physiological, breastmilk, infection, hypothyroidism

• Serum bilirubin level
• FBC and film
• Blood group
• Maternal blood group
• DCT
• Consider G6PD levels

• Prematurity
• Sepsis
• Bruising
• Cephalohematoma
• Polycythaemia
• Delayed passage of meconium
• Breastfeeding
• Certain ethnic groups, esp. Chinese

Kernicterus/Bilirubin encephalopathy:

Neurological syndrome resulting from neurotoxic affects of unconj bilirubin on basal ganglia and brainstem nuclei.

Unconj bilirubin is lipophilic and can cross the BBB

Rare, but 10% mortality & 70% mobidity

Short-term (first 24hrs):

• Phase 1: poor suck, hypotonia, lethargy
• Phase 2: hypertonia, opisthotonos
• Phase 3: less hypertonia, high pitched cry, hearing & visual loss, poor feeding & athetosis

Long-term:

• choreoathetoid cerebral palsy
• upward gaze palsy
• sensorineural hearing loss
• intellectual delay (less common)

1. Adequate fluid intake
2. phototherapy (biliblanket, phototherapy lights)
3. Exchange transfusion (use table)