Clinical Findings Which May Indicate That Neonatal Hyperbilirubinemia Is Secondary to Another Disorder

The presence of certain clinical findings may be indicate that hyperbilirubinemia in a newborn term infant is secondary to another condition.

Conditions to consider:

(1) hemolytic disease (hemolytic disease of the newborn, G6PD deficiency, other)

(2) sepsis, galactosemia or inherited metabolic disorder

(3) cholestatic jaundice

Clinical Finding	Condition
family history of hemolysis	hemolytic disease (G6PD deficiency, other)
ethnicity	hemolytic disease (G6PD deficiency, other)
onset of jaundice < 24 hours	hemolytic disease
serum bilirubin rises > 0.5 mg/dL per hour	hemolytic disease
serum bilirubin shows rapid increase after 24-48 hours	hemolytic disease (G6PD deficiency, other)
failure to respond to phototherapy	hemolytic disease
jaundice persistent > 3 weeks	cholestasis
unexplained anemia	hemolytic disease
positive direct antiglobulin test	hemolysis (hemolytic disease of the newborn)
pallor	hemolytic disease
hepatosplenomegaly	hemolytic disease, sepsis or metabolic disorder
vomiting	sepsis or metabolic disorder
lethargy	sepsis or metabolic disorder
poor feeding	sepsis or metabolic disorder
excessive weight loss	sepsis or metabolic disorder
apnea	sepsis or metabolic disorder
fever or temperature instability	sepsis or metabolic disorder
tachypnea	sepsis or metabolic disorder
high-pitched cry	sepsis or metabolic disorder
dark urine positive for bilirubin	cholestasis
light-colored stools	cholestasis

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