How is the severity of neonatal jaundice assessed?

Severity is assessed by measuring the bilirubin (transcutaneous bilirubinometer for screening; serum bilirubin to confirm/guide treatment) and plotting it on a treatment threshold chart against the baby's age (in hours) and gestation.

Clinical examination (extent of jaundice, the baby's wellbeing) supports this, but visual assessment alone is unreliable - bilirubin must be measured.

Clinical relevance. Assessing jaundice severity by measuring bilirubin and plotting it against age/gestation (not by eye) determines the need for treatment.

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Assessing the severity of neonatal jaundice

Bilirubin measurement plotted against age/gestation determines severity and treatment.

Measure the bilirubin

• Transcutaneous bilirubinometer - useful for screening (non-invasive).
• Serum bilirubin - to confirm and guide treatment (and when transcutaneous is high, in the first 24 hours, or in preterm babies).

Plot against thresholds

• Plot the level on a bilirubin treatment threshold chart against the baby's age in hours and gestational age - this determines whether the level is at the phototherapy or exchange-transfusion threshold.
• The rate of rise also matters.

Clinical assessment

• Extent of jaundice (cephalocaudal progression) and the baby's wellbeing (feeding, alertness, signs of encephalopathy) support assessment.

Key point

• Visual assessment alone is unreliable (especially in dark skin) - bilirubin must be measured to assess severity accurately.