Context: Neutrophils can demonstrate various inclusions upon examination in the stained peripheral blood smears. Hyperbilirubinemia is a common entity in the neonatal age group. Unusually, smears of children with hyperbilirubinemia can demonstrate bilirubin crystals in the white blood cells especially neutrophils.

Aims: To study the frequency of occurrence of these uncommon crystals in blood films of neonates which were examined during the work up for neonatal sepsis.

Settings and Design: This cross sectional study was conducted in a tertiary teaching hospital

Methods and Material: Neonates who were clinically suspected to have sepsis were evaluated for evidence of sepsis with the help of blood culture, blood cell counts and peripheral blood examination. Attention was paid to the presence of bilirubin crystals in the white blood cells and the same recorded. 

Results: Smears examined from 174 neonates clinically suspected to have neonatal sepsis demonstrated the presence of these bilirubin crystals in 4.6% of the cases. Most of these cases were proven to have sepsis by blood culture. 

Conclusions: Bilirubin crystals are a rare finding in smears of neonates having hyperbilirubinemia. They are frequently seen in septicemic neonates.

Keywords: Hyperbilirubinemia; Bilirubin Crystals; Neonates; Sepsis.