Which single feature, if present in a neonate with unconjugated hyperbilirubinaemia, is sufficient to classify the jaundice as pathological rather than physiological?

• A Total serum bilirubin peaking between 5 and 6 mg/dL on day 4 of life
• B Onset of visible jaundice within the first 24 hours of life ✓
• C Jaundice visible on the trunk but sparing the palms and soles
• D Serum bilirubin declining gradually after the fifth day in a term baby

Explanation

Jaundice appearing within the first 24 hours always warrants evaluation because it implies haemolysis, infection, or another pathological process; physiological jaundice never begins that early. Options A, C and D all describe features consistent with physiological jaundice: a peak under about 12 mg/dL, cephalocaudal progression sparing palms and soles, and spontaneous decline after day 4 or 5. Rate of rise exceeding 5 mg/dL per day is another pathological marker.

Reference: Nelson Textbook of Pediatrics, 21st ed.

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Written and medically reviewed by the StethoPrep medical team.