Aetiology and differential diagnosis of jaundice in newborns. Blood exchange transfusion.

1. Big picture

Neonatal jaundice is yellow discoloration of the skin and sclera caused by increased bilirubin. It is very common, but the key exam task is to separate:

physiological unconjugated jaundice
from
pathological jaundice that may cause kernicterus or indicate liver/biliary disease

The examiner wants you to think in three steps:

1. Is the jaundice early, severe, prolonged, or conjugated?
2. Is bilirubin unconjugated or conjugated?
3. Does the baby need feeding support, phototherapy, IVIG, or exchange transfusion?

The dangerous complication of severe unconjugated hyperbilirubinaemia is:

Acute bilirubin encephalopathy → kernicterus.

The most important emergency treatment for dangerously high bilirubin is:

Intensive phototherapy first, and exchange transfusion if bilirubin remains at/above exchange threshold or there are signs of bilirubin encephalopathy.

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