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Neonatal jaundice
Neonatal jaundice is usually a transient rise in unconjugated bilirubin, but onset in the first 24 hours, a rapid rise, a raised conjugated fraction or prolonged jaundice always needs work-up.
Why it matters in the exam
This is one of the most frequently examined neonatal topics. The question builds a case of a jaundiced newborn and asks whether it is physiological or pathological, which test comes next (direct Coombs, blood group, blood count, G6PD, conjugated bilirubin) and when to start phototherapy or consider exchange transfusion. Common distractors are stopping breastfeeding "to bring the jaundice down" and relying on visual assessment.
The second key point is separating unconjugated from conjugated bilirubin. A raised conjugated fraction is always pathological and points to liver or biliary disease; biliary atresia is the diagnosis that must not be missed, because a Kasai operation works better the earlier it is done, ideally before 60 days of age. In Israel, remember that G6PD deficiency is common in some communities and raises the risk of severe jaundice.
When approaching the question, work in a fixed order: first ask when the jaundice appeared, then which type of bilirubin is rising, and only then check the treatment threshold for gestational age and risk factors. This quickly rules out most distractors and leads to the right answer even when the case is long.
Key points
- Jaundice in the first 24 hours is pathological until proven otherwise.
- The phototherapy decision depends on the TSB, gestational age, hours of life and neurotoxicity risk factors.
- A conjugated bilirubin above 1.0 mg/dL is always pathological and needs a cholestasis work-up.
- Breast-milk jaundice appears after the first week and breastfeeding continues.
- Biliary atresia: pale stools and dark urine; early Kasai, ideally before 60 days of age.
Summary table
| Type | When it appears | Key feature | What to do |
|---|---|---|---|
| Physiological | After 24 hours, peak on day 3–5 in a term baby | Unconjugated bilirubin, well baby | Follow TcB/TSB on an hour-specific nomogram |
| Haemolytic (ABO/Rh incompatibility, G6PD, spherocytosis) | Within the first 24 hours or a rapid rise | Positive direct Coombs in immune disease; anaemia and reticulocytosis | Early phototherapy; IVIG in immune disease approaching the exchange threshold |
| Breastfeeding jaundice (under-feeding) | First week | Weight loss, few stools and wet nappies | Improve breastfeeding, do not stop it |
| Breast-milk jaundice | After the first week, up to 12 weeks | Thriving baby, unconjugated bilirubin | Continue breastfeeding; exclude other causes |
| Cholestatic (conjugated) | Any age, often after two weeks | Pale stools, dark urine, conjugated bilirubin above 1.0 mg/dL | Ultrasound and urgent work-up for biliary atresia |
Free exam questions
אצל ילוד בן שבוע שנולד במועד ש מעקב ההיריון שלו היה דל, הופיעו .פרכוס כללי ופריחה פטכיאלית בבדיקה גופנית לציין צהבת ,הפטוספלנומגליה, ו כוריורטיניטיס. בב דיקות העזר לציין הידרוצפלוס ב- US מוח והסתיידויות אינטרה- ( קרניאליות intra-cranial calcifications ) ב- MRI איזה מבין הבאים הוא המחולל הסביר ביותר של ?מחלתו (the question as examined, in Hebrew)
- א. Herpes simplex virus
- ב. Toxoplasmosis
- ג. Treponema pallidum
- ד. Zika virus
בן 10 שנים, סובל מאירועים חוזרים של כיבים כואבים בפה, כאבי בטן ו .שלשולים בבדיקה– .נצפו מס' צלקות בפין ובפרינאום, בדיקת הלוע תקינה במסגרת ה בירור , 48 שעות לאחר הזרקה תת עורית של סליין- .הופיעו פוסטולות איזה ביטוי נוסף שכיח למצוא במחלתו ?הסבירה (the question as examined, in Hebrew)
- א. אובאיטיס
- ב. צהבת ישירה
- ג. מיוזיטיס
- ד. לימפאדנופתיה
A 6-week-old boy, normal pregnancy and birth, breastfed, gaining weight well. He was referred for examination due to jaundice. In blood tests: Total Bilirubin 10 mg/dl Direct Bilirubin 0.6 mg/dl In physical examination, there was no evidence of hepatosplenomegaly. A repeat blood test after a week showed similar values. What is the most likely cause of his condition?
- A. PHYSIOLOGICAL JAUNDICE
- B. GILBERT SYNDROME
- C. BILIARY ATRESIA
- D. BREAST MILK JAUNDICE
In the full version for subscribers
- A simple algorithm
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The full version is open to subscribers of: Pediatrics, Medical licensing exam (IMLE), Family medicine.
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Sources
- AAP Clinical Practice Guideline Revision: Management of Hyperbilirubinemia in the Newborn Infant 35 or More Weeks of Gestation, 2022 — Phototherapy and escalation-of-care thresholds
- Nelson Textbook of Pediatrics, 22nd edition (2024) — Jaundice and Hyperbilirubinemia in the Newborn
Sources are given for further reading; the text is written afresh and not copied from them.
Reviewed by the Examqo AI Professor · 2026-11-02. The text may contain errors; when in doubt, check the source.