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January 3, 1977

Jaundice in the Newborn: Algorithmic Diagnosis of Conjugated and Unconjugated Hyperbilirubinemia

Author Affiliations

From the Division of Gastroenterology, Department of Pediatrics, University of California, San Francisco.

JAMA. 1977;237(1):58-62. doi:10.1001/jama.1977.03270280060027

JAUNDICE in the newborn and young infant differs in several important respects from jaundice in older patients. First, almost uniquely in the newborn, bilirubin may be a cause of disease as well as its consequence. The potential toxicity of the unconjugated pigment lends urgency to diagnostic deliberations. Second, the first two months after birth are a period of continuous maturational and adaptive change, which alters the character and manifestations of disease processes. Third, many inherited disorders manifest themselves during the newborn period. It is important to measure without delay the severity of unconjugated hyperbilirubinemia in newborns, since high concentrations of the unconjugated pigment may cause brain damage. The causes of conjugated hyperbilirubinemia should also be investigated promptly, but do not usually constitute emergencies.

Studies have been made of bilirubin metabolism,1 causes of unconjugated neonatal bilirubinemia (physiologic, hemolytic, and hereditary),2 and conditions associated with conjugated hyperbilirubinemia (cholestatic jaundice) in