Clinical features

• Pathological jaundice may be clinically obvious at birth or within 24h (distinguishing it from the common physiological anaemia which occurs >48h after birth, ffl Hyperbilirubinaemia, p444).

• Anaemia may be severe depending on cause.

• Infections are common cause of hyperbilirubinaemia (ffl p444) with specific clinical findings. In utero infections (TORCH) do not usually

434 cause severe jaundice cf. post-natal bacterial sepsis where jaundice may be striking and associated with MAHA.

• Splenomegaly at birth indicates a prenatal event; when noted later it may be secondary to splenic clearance of damaged RBC and is non-specific.

• Kernicterus is the major complication of neonatal hyperbilirubinaemia.

• Family history and drug history may be informative.

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