What are the key clinical features to assess in a newborn presenting with jaundice?

When assessing a newborn presenting with jaundice, key clinical features to evaluate include:

• Visual inspection of jaundice: Examine the naked baby in bright, preferably natural light, checking the skin, sclerae, and gums for yellow discoloration. Press lightly on the skin to detect jaundice in blanched areas, noting that jaundice may be harder to see in babies with darker skin pigmentation.
• Age of onset: Note if jaundice appears within the first 24 hours of life, as this requires urgent evaluation.
• Serum bilirubin levels: Measure and record serum bilirubin urgently in babies with suspected jaundice, especially within 2 hours if jaundice is present in the first 24 hours, and every 6 hours thereafter until levels are stable or below treatment thresholds.
• Risk factors for significant hyperbilirubinaemia: Assess for gestational age under 38 weeks, previous sibling with neonatal jaundice requiring phototherapy, and maternal intention to breastfeed exclusively.
• Signs of acute bilirubin encephalopathy: Look for clinical features such as lethargy, poor feeding, high-pitched crying, hypotonia or hypertonia, and abnormal movements, which indicate urgent need for intervention.
• Hydration and feeding status: Evaluate feeding adequacy and hydration, as poor feeding can exacerbate jaundice.
• Urine and stool color: Check for dark urine or pale, chalky stools which may suggest conjugated hyperbilirubinaemia or underlying pathology.

These assessments guide the urgency and type of management required for neonatal jaundice.

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