Ans. c. 3 mg/dL
Scleral icterus is the first sign of jaundice apparent on a physical exam. All babies are predisposed to elevated serum bilirubin in the first few days of life. This predisposition is due to increased production, increased reabsorption or decreased removal which is a result of accelerated RBC breakdown, transient liver enzyme insufficiency, enterohepatic circulation.
Jaundice is usually clinically identified with a bilirubin level greater than 3 mg/dL but may be less apparent in certain lighting or in patients with certain skin coloring.
Sublingual icterus also occurs at the same time as scleral icterus. However scleral icterus is more likely to be noticed. Jaundice before 24 hours of birth is always pathological.
When bilirubin rises up to about 8 mg/dL, there is generalized yellowish discoloration. Higher levels of bilirubin generally point towards a surgical cause of jaundice.