How is it Diagnosed?
Neonatal jaundice is diagnosed through a combination of clinical observation and
laboratory testing. Clinically, it is first noticed as a yellow discoloration of the skin and
sclera, usually starting on the face and progressing caudally. Physical assessment is
guided by Kramer’s scale, which estimates serum bilirubin levels based on the extent of
visible jaundice.
Diagnosis is confirmed through measurement of total and direct (conjugated) serum
bilirubin levels. Transcutaneous bilirubinometry (TcB) provides a non-invasive screening
tool, especially useful in the early neonatal period, and abnormal readings are followed
by serum bilirubin tests. Age in hours and birth weight are important parameters when
interpreting bilirubin levels, using nomograms like the Bhutani chart.
Additional tests may include blood type and Coombs test to rule out hemolytic disease
due to Rh or ABO incompatibility. A complete blood count, reticulocyte count, and
peripheral smear help identify hemolysis or sepsis. Liver function tests and thyroid
screening may be necessary if prolonged or conjugated jaundice is suspected.
Distinguishing between physiological and pathological jaundice is essential. Jaundice
appearing within the first 24 hours, lasting more than two weeks, or associated with
systemic symptoms requires prompt investigation to avoid complications like
kernicterus. Regular monitoring and timely diagnostics ensure effective management
and prevention of bilirubin-induced neurologic dysfunction.