29/01/2026
Physiological Jaundice in a Newborn
Definition and typical pattern
Normal, benign jaundice that appears in the first 2–5 days of life and resolves without treatment.
Predominantly unconjugated bilirubin due to increased bilirubin production and immature hepatic conjugation.
Low-risk features (predictors of benign course)
Term infant (≥37 weeks gestation) with appropriate birth weight.
Adequate, effective breastfeeding established early; thriving with satisfactory urine and stool patterns.
Jaundice that begins after 24 hours of life and progresses from face to trunk (cephalocaudal spread) and then to extremities.
No signs of illness (feeding well, normal activity, good tone).
Direct bilirubin consistently low or undetectable.
No significant bruising, cephalohematoma, or rapid weight loss (>10% in first days).
Absence of risk factors for severe hyperbilirubinemia (see below).
Clinical assessment for low-risk status
History: maternal health, pregnancy duration, birth weight, feeding adequacy, stool frequency, urine output.
Examination: hydration status, tone, scleral icterus, skin jaundice distribution, signs of illness or dehydration.
Basic labs (if indicated): total bilirubin level to confirm mild unconjugated hyperbilirubinemia, but many cases are monitored clinically without immediate labs in clearly low-risk infants.
Management principles for low-risk physiologic jaundice
Monitor and reassure parents; educate about expected duration and when to recheck.
Encourage and support feeding: ensure effective breastfeeding or formula intake to promote bilirubin clearance.
Hydration and voiding/stooling patterns: normal urine output and stooling help bilirubin excretion.
Follow-up plan: schedule a recheck within 24–72 hours or as per local guidelines to ensure bilirubin level is trending down.
No routine pharmacologic treatment needed for clearly low-risk physiologic jaundice.
