Neonatal Jaundice

Neonatal Jaundice Chart 2025

Key Updates 2025 from Paediatric Protocols 5th Edition

1. New Classification System

Now stratified by Gestational Age (weeks) + Neurotoxicity Risk Factors (no more low / moderate / high risk)

2. Updated Treatment Thresholds

Several thresholds are higher than the previous edition

3. Extended Time Axis

Includes > 96 hours of life

Quickly calculate age in hours since birth — useful for neonatal assessments.

🕐 Time of Birth

📅 Current Time

Notes

Infants with weight loss > 7% should be referred
Transcutaneous Bilirubinometer (TcB) –
- TSB should be measured if TcB exceeds or is within 50μmol/l (3mg/dL) of the phototherapy threshold or if the TcB is ≥ 256μmol/l (15mg/dL).
- TcB is not to be used for infants on phototherapy and not recommended for infants less than 24hours of life.
- TcB can be used for monitoring if it has been 24 hours since cessation of phototherapy.

Prolonged Jaundice

Prolonged jaundice is defined as visible jaundice that persists beyond 14 days in a term baby and 21 days in a preterm baby.
Examination (red flags):
- Growth failure
- Jaundice, Pallor
- High-pitched cry, temperature instability, lethargy, dehydration,
- Neurological: muscle tone abnormalities, hyperexcitable neonatal reflexes (bilirubin-induced neurologic dysfunction, BIND)
- Hepatosplenomegaly
Investigations
- Serum bilirubin (total, direct, and indirect)
  - REFER if serum direct (conjugated) bilirubin concentration > 25 micromol/l or > 20 percent of total bilirubin
- Full blood count (FBC) with retic count / full blood picture (FBP), blood group , Coomb’s test Liver function test (Total protein, serum albumin, ALT, AST, ALP)
- Thyroid function test
- Urine FEME, Urine C&S
- G6PD screen (if cord G6PD screen not available)

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