PE19.15 | Neonatal Hyperbilirubinemia — Summary & Reflection

KEY TAKEAWAYS

Neonatal hyperbilirubinaemia requires systematic clinical assessment and prompt management to prevent kernicterus. Key principles to internalise: (1) jaundice in the first 24 hours is ALWAYS pathological; (2) use Kramer's zones for bedside estimation but always confirm with serum TSB; (3) apply the AAP/NNF Bhutani nomogram — thresholds are hour- and gestation-specific, NOT fixed; (4) conjugated (direct) bilirubin >1 mg/dL is never physiological and demands urgent conjugated-jaundice work-up including hepatobiliary ultrasound; (5) phototherapy works by photoisomerisation (needs correct wavelength, irradiance, and surface area); (6) exchange transfusion is a double-volume procedure indicated when TSB meets the nomogram threshold or when acute BIND is present; (7) biliary atresia is a surgical emergency with a narrow window — the Kasai procedure must be done before 60 days for best outcome.

REFLECT

You are seeing Baby Rishi again 12 hours after initiating intensive phototherapy for ABO-incompatible haemolytic jaundice. His TSB has dropped from 17.5 mg/dL to 14 mg/dL. His parents ask: 'Doctor, will this affect his brain? When can we stop the blue lights?' Think through: (1) How do you counsel the parents about the current status and the likelihood of permanent neurological injury given the current trajectory? (2) When would you stop phototherapy, and what follow-up would you arrange after discharge? (3) If this baby were G6PD-deficient instead of ABO-incompatible, what would you counsel the parents about long-term triggers to avoid? Record your reasoning — this is exactly the conversation you will have as a junior doctor.