Clinical features

• Note: clinical jaundice in the first 24h of life is always pathological.

• Presenting after this, the jaundice may/not be pathological—usually not. Inadequate food/fluid intake with dehydration can aggravate the physiological bilirubin. A higher concentration is acceptable for the full-term breast-fed baby (serum bilirubin 240jmol/L) than bottle-fed baby (190jmol/L).

• Jaundice in an active healthy infant is likely to be physiological.

• In a sick infant the underlying cause of the jaundice may be clinically evident—e.g. infection, anaemia, shock, asphyxia, haemorrhage (may be occult).

• Physical examination—hepatosplenomegaly is pathological.

• Maternal history (drugs, known condition) and family history may help.

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