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Emergency Medical Minute


Jan 18, 2021

Contributor: Jared Scott, MD

Educational Pearls:

  • Bilirubin is natural breakdown product of red blood cells but can be neurotoxic if levels become too high
  • Fetal red blood cells are fragile and break down easier, leading to higher bilirubin levels in neonates 
  • Immature livers and increased intestinal absorption from sterile bowels also contribute to elevated levels and jaundice in all neonates
  • Other risk factors for neonatal jaundice include: temperature instability, poor feeding, hypoxia at birth, and being of East Asian descent
  • Neonatal bilirubin levels are referenced to time since birth using a nomogram to determine the need for light therapy (or exchange transfusion)


Mitra S, Rennie J. Neonatal jaundice: aetiology, diagnosis and treatment. Br J Hosp Med (Lond). 2017 Dec 2;78(12):699-704. doi: 10.12968/hmed.2017.78.12.699. PMID: 29240507.

Woodgate P, Jardine LA. Neonatal jaundice: phototherapy. BMJ Clin Evid. 2015 May 22;2015:0319. PMID: 25998618; PMCID: PMC4440981.

Colletti JE, Kothari S, Jackson DM, Kilgore KP, Barringer K. An emergency medicine approach to neonatal hyperbilirubinemia. Emerg Med Clin North Am. 2007 Nov;25(4):1117-35, vii. doi: 10.1016/j.emc.2007.07.007. Erratum in: Emerg Med Clin North Am. 2008 Feb;26(1):xi. Kothori, Samip [corrected to Kothari, Samip]. PMID: 17950138.

Summarized by Jackson Roos, MS4 | Edited by Erik Verzemnieks, MD


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