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