Neonatal Jaundice

Neonatal hyperbilirubinaemia refers to an elevated bilirubin concentration in a newborn's blood. Jaundice is the visible yellow discolouration of the skin and sclera caused by bilirubin accumulation. Neonatal jaundice is common during the first week of life because newborns have increased bilirubin production and immature bilirubin clearance. Most neonatal jaundice is transient and resolves without complications. However, excessive unconjugated bilirubin can cross the blood–brain barrier and cause neurological injury, so the nurse's question is never only "how yellow is this baby?" It is "how much bilirubin, at what age in hours, in which infant, and how fast is it moving?" One mental model carries the whole topic. Bilirubin moves along a supply line: red cells break down, unconjugated bilirubin travels on albumin to the liver, the liver conjugates it, and the gut removes it. Anything that adds supply, reduces albumin carriage, slows conjugation or lets bilirubin back in from the gut raises the level. Anything that opens the blood–brain barrier makes that level more dangerous. ### How the bilirubin load builds Newborn bilirubin is produced mainly when fetal red blood...