At which day, Physiological Jaundice commonly appears in the newborn?

Appeared in: NIA - 29 January 2023

Explanation

Physiological jaundice is a normal process in newborns, typically becoming visible between 24 and 72 hours (Day 2-3) after birth.
This occurs due to the breakdown of fetal red blood cells, leading to increased bilirubin production, combined with the transient immaturity of the newborn's liver to conjugate and excrete it.
The peak level of bilirubin in physiological jaundice is usually seen between the 2nd and 4th day of life.
This timing helps differentiate it from pathological jaundice, which appears within the first 24 hours of life and is a cause for concern.

Option A: Jaundice appearing on the 1st day (within 24 hours of birth) is considered pathological, not physiological. It signals an underlying medical issue.
Option C: This period (4th to 7th day) is typically when physiological jaundice reaches its peak intensity, not when it first appears. The onset is earlier.
Option D: Jaundice that first appears or persists after the 7th day is classified as prolonged jaundice, which requires further investigation and is not typical physiological jaundice.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Onset of Physiological Jaundice in Newborns as background academic context rather than a clinical decision trigger.
A nurse's primary role is to monitor newborns for the onset and progression of jaundice. Accurate assessment helps in early identification of pathological conditions.
Nurses should educate parents about the signs of worsening jaundice (e.g., lethargy, poor feeding, jaundice spreading to palms and soles) and when to seek medical help.
Promoting adequate breastfeeding (8-12 times a day) is a key nursing intervention, as it helps lower bilirubin levels by increasing stool output.

How to Approach the Question

Identify the key concept in the question: 'Physiological Jaundice' and 'commonly appears'.
Recall the standard timeline for the onset of physiological jaundice in a newborn.
Evaluate each option against this timeline.
Option A (1st Day) is too early and indicates a pathological process.
Option B (2nd to 3rd Day) matches the known onset of physiological jaundice.
Options C and D (4th-7th day and after 7th day) represent the peak or prolonged phases, not the initial appearance.

Concept Tested & Keywords

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E6 Ghai Essential Pediatrics(pp 26-904 of 913) p. 168-170

E6 Text Book Of Pediatric Nursing 3rd Panchali Pal — Part 1 (pp 36-238 of 713) p. 190-192

E6 Nelson Textbook of Pediatrics(2024) — Volume 1 p. 1120-1122

Practise the full NIA - 29 January 2023

Attempt every question from this paper in a timed mock, then review the full solution for each one.