What are the key clinical signs to assess the severity of neonatal jaundice in a newborn?

Signs of jaundice spreading from the head downwards with increasing severity (cephalocaudal progression) can be observed, but visual assessment alone is not reliable for severity assessment ¹.

Examine the sclerae and gums, and press lightly on the skin to check for signs of jaundice in 'blanched' skin, especially in the first 72 hours ².

Signs of illness such as lethargy, poor feeding, irritability, vomiting, or hypotonia followed by hypertonia suggest more severe hyperbilirubinaemia or bilirubin encephalopathy ¹.

Dark urine and pale stools can indicate underlying liver issues and are signs to consider in severity assessment ¹.

Features like a rapidly rising bilirubin level (>8.5 μmol/litre per hour) and clinical signs of acute bilirubin encephalopathy are critical indicators of severity ¹.