Jaundice is a yellow coloration of the skin and the whites of the eyes that results from the accumulation of bilirubin, a normal product of hemoglobin breakdown. Most newborns have some degree of normal (physiologic) jaundice due to the breakdown of excessive red blood cells and relative immaturity of the liver, which is responsible for processing bilirubin for excretion.

Physiologic jaundice occurs in up to 60% of newborns, with bilirubin level peaking at 3-4 days of life, then falling. Pathologic jaundice results from many conditions that serve to further increase bilirubin production or slow processing or excretion of bilirubin from the body. Jaundice can also be associated with breast-feeding (breast-feeding jaundice and breast milk jaundice) and is found in higher incidence in Native American and Asian populations.

The severity of jaundice can be estimated by a transcutaneous bilirubin measurement, with abnormal reads confirmed with a total and fractioned serum bilirubin level. Hyperbilirubinemia can be divided into 2 main types: conjugated (direct) and unconjugated (indirect). High levels of unconjugated bilirubin have been shown to be neurotoxic. Thus specific evaluation and treatment guidelines for the assessment and management of hyperbilirubinemia in infancy have been developed to help prevent bilirubin-induced neurologic damage (BIND). Treatment options are dictated by severity and cause of the bilirubin elevation as well as other risk factors.

Related topic: hyperbilirubinemia