Neonatal jaundice

Neonatal jaundice, clinically known as neonatal hyperbilirubinemia and icterus neonatorum, is the yellowish discoloration of the white part of the eyes (sclerae) and skin in newborn infants caused by an elevated concentration of bilirubin in the blood (hyperbilirubinemia). It is one of the most frequently encountered medical conditions in the neonatal period, affecting approximately 60% of term and 80% preterm newborns within the first week of life. Globally, over 100,000 late-preterm and term babies die each year as a result of jaundice, particularly in low- and middle-income countries.

Bilirubin is a yellow-orange pigment naturally produced during the breakdown of red blood cells. While mild jaundice in newborns is generally harmless and self-resolving, elevated bilirubin levels, if left untreated, can cross the blood-brain barrier to cause permanent neurological damage. The condition is known as kernicterus or chronic bilirubin encephalopathy (CBE).

Neonatal jaundice has been described in medical literature for centuries. The severe, often fatal form, known in Latin as icterus gravis neonatorum, was recognized long before its cause was understood. The discovery that phototherapy could treat jaundice is credited to a nurse at Rochford General Hospital, England, in 1965, who noticed that infants exposed to sunlight had less jaundice. This observation led to the landmark 1968 Pediatrics publication by Lucey et al., establishing phototherapy as an effective treatment.

In most cases, there is a specific underlying physiologic disorder. With modern universal bilirubin screening, phototherapy, and exchange transfusion, the incidence of severe complications has been dramatically reduced.