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Conjunctival Icterus – An Important but Neglected Sign of Clinically Relevant Hyperbilirubinemia in Jaundiced Neonates

[ Vol. 13 , Issue. 3 ]


Abeer Azzuqa and Jon F. Watchko*   Pages 169 - 175 ( 7 )


Background: Conjunctival icterus is a largely neglected physical sign that may be helpful in identifying neonates with clinically relevant hyperbilirubinemia by practitioners in the hospital and outpatient clinic or parents at home.

Objective: A recent NICU based study reported that conjunctival icterus is often a sign of significant (TSB ≥ 17 mg/dl) hyperbilirubinemia and TSB levels ≥ 76th-95th percentile on the Bhutani nomogram. In contrast, others report that conjunctival icterus, although frequently present at high TSB levels, may also be detected at lower TSB concentrations; suggesting instead that its absence may help to rule out significant hyperbilirubinemia.

Result and Conclusion: The current review details the nature of conjunctival icterus and presents new data on its clinical occurrence in relation to TSB levels that re-affirm its correlation with elevated TSB concentrations and use to trigger TSB measurement in the jaundiced neonate.


Scleral icterus, conjunctiva, Bhutani nomogram, bilirubin screening, neonatal jaundice, dermal icterus, cutaneous jaundice.


Division of Newborn Medicine, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, 15213, Pennsylvania, Division of Newborn Medicine, Department of Pediatrics, Magee-Womens Hospital, 300 Halket Street, Pittsburgh, Pennsylvania 15213

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