Neonatal Jaundice Treatment in Mumbai

Our Approach to Jaundice Management

Measure accurately. Treat at the right threshold. Protect the brain.

The management of neonatal jaundice seems deceptively simple on the surface - measure bilirubin, put the baby under lights if it's high enough. But the clinical decision-making underneath this simplicity is considerably more nuanced. The threshold for starting phototherapy isn't the same for every baby - it depends on gestational age, chronological age in hours, and the presence of risk factors that accelerate neurological toxicity at lower bilirubin levels. Getting these decisions right for every individual baby, consistently, is the core competency our neonatal team brings.

At Shree Hospitals, our approach to newborn hyperbilirubinemia diagnosis and safe care is protocol-driven, evidence-based, and parent-inclusive - ensuring that families understand exactly what is being treated, why, and what to watch for once their baby goes home.

1. Systematic Risk Assessment From Birth
   
   Not all babies with jaundice are equal in their risk profile:

• Gestational age at delivery - preterm babies have less mature liver conjugation capacity, requiring lower treatment thresholds
• Blood group compatibility between mother and baby - ABO and Rh incompatibility causing haemolytic jaundice with characteristically rapid bilirubin rise
• G6PD deficiency testing in at-risk ethnic groups - identifying babies with enzyme deficiency predisposing to haemolysis and severe jaundice
• Family history of jaundice requiring treatment in a sibling
• Feeding adequacy assessment - breastfed babies with poor intake in the first days have higher jaundice risk

2. Precise Bilirubin Measurement

• Transcutaneous bilirubinometry (TcB) - non-invasive, bedside, point-of-care screening measuring bilirubin through the skin without a needle
• Serum total bilirubin (TSB) measurement - confirmatory blood test providing definitive bilirubin level for treatment decisions
• Hour-specific bilirubin nomograms - the most important tool in jaundice management, plotting the bilirubin level against the baby's exact age in hours to determine whether it falls in the low, intermediate, or high-risk zone
• Repeat measurements at defined intervals based on the rate of rise - the speed of bilirubin increase is often as clinically important as the absolute level

3. Phototherapy - Safe, Effective, Gold Standard
   
   When the bilirubin level meets the threshold for treatment:

• Phototherapy and bilirubin monitoring in Mumbai using high-intensity blue-spectrum LED lights
• Conventional single-surface phototherapy for mild to moderate elevation
• Intensive double-surface phototherapy - lights both above and below the baby simultaneously - for rapidly rising or high bilirubin levels
• Fibre-optic biliblanket therapy allowing the baby to be held and fed during treatment, reducing parental distress
• Four to six hourly bilirubin rechecks during active phototherapy to track response
• Eyes and genitals protected during phototherapy; skin temperature monitoring maintained

4. Managing the Underlying Cause
   
   Simply treating the bilirubin level without understanding why it's elevated risks undertreating the true disease:

• IVIG (intravenous immunoglobulin) for significant ABO or Rh incompatibility - reducing antibody-driven haemolysis and frequently preventing the need for exchange transfusion
• Breastfeeding optimisation - ensuring adequate milk transfer, as inadequate intake significantly contributes to prolonged jaundice in the early days
• Treating co-existing conditions - sepsis, polycythaemia, or cephalhaematoma all contributing to jaundice and requiring separate management

5. Exchange Transfusion When Needed
   
   For critically elevated bilirubin threatening bilirubin brain damage prevention:

• Double-volume exchange transfusion - replacing the baby's bilirubin-laden blood with compatible donor blood
• Performed in our NICU by experienced neonatologists under continuous monitoring
• Reserved for cases where phototherapy has failed or bilirubin is at levels posing immediate kernicterus risk
• Post-transfusion phototherapy continued to prevent rebound bilirubin rise

6. Discharge Planning & Post-Discharge Monitoring

• Clear discharge criteria - bilirubin below treatment threshold, well below the exchange level, and on a declining trajectory
• Written guidance for parents on signs of worsening jaundice after discharge
• Structured bilirubin recheck appointment within 24 to 48 hours of discharge for babies with persisting risk factors
• Parental education on jaundice in newborns - distinguishing normal from concerning patterns and when to return promptly.