How should I approach the management of jaundice in a term newborn, and when should I consider referral to a specialist?

In a term newborn, management of jaundice involves initial assessment with visual inspection in bright, natural light, examining the sclerae and gums, and pressing lightly on the skin to check for jaundice, especially in the first 72 hours of life ¹.

If jaundice is suspected or visible within the first 24 hours, measure and record the serum bilirubin level urgently (within 2 hours), and continue to monitor every 6 hours until the level is below the treatment threshold or stable and falling ¹.

For babies over 24 hours old, measure and record the bilirubin level urgently (within 6 hours) ¹.

Use serum bilirubin measurement in babies with visible jaundice, especially in the first 24 hours or if the baby is preterm (<35 weeks) ¹.

Management should be guided by the bilirubin level in relation to the postnatal age in hours, using the threshold table and treatment threshold graphs ¹.

Offer parents or carers information about treatment, including the expected duration, reassurance about breastfeeding, and signs to watch for ¹.

Referral to a specialist should be considered if the bilirubin level is at or above the treatment threshold, if there is rapid rise in bilirubin, or if there are signs of underlying pathology such as conjugated hyperbilirubinaemia, dark urine, pale stools, or if the baby has persistent or prolonged jaundice beyond 14 days in term infants ¹.