Snap Shot A two-week-old, healthy, full-term infant is slightly jaundiced. Labs show a total bilirubin of 18 mg/dl (<7 mg/dl) and a direct bilirubin of 0.8 mg/dl (0-0.4 mg/dl). Introduction May be physiologic or pathologic Physiologic jaundice occurs between days 3-5 and is clinically benign indirect (unconjugated) billirubin rise occur in 50% of neonates during first week of life results from increased bilirubin production due to degradation of HbF relative deficiency in glucuronyl transferase in immature liver Pathologic jaundice jaundice in the first day of life is always pathologic can be direct or indirect hyperbilirubinemia indirect causes Crigler-Najar's syndrome Gilbert's synrome breast milk jaundice persistence of physiologic jaundice beyond first week of life breast feeding failure jaundice lactation failure leads to inadequate oral intake, hypovolemia, and hyperbilirubinemia hemolytic anemia e.g. spherocytosis, G6PD deficiency direct causes Dubin-Johnson syndrome Rotor's syndrome infections metabolic causes e.g. galactosemia, alpha-1-antitrypsin deficiency extrahepatic biliary atresia destruction of bile ducts leads to hepatomegaly and cirrhosis Evaluation Labs elevated direct and total bilirubin Treatment Physiologic jaundice requires no treatment Phototherapy light photo-oxidizes unconjugated bilirubin, making it water-soluble and able to be excreted renally Prognosis, Prevention, and Complications High bilirubin levels can lead to kernicterus results from the irreversible deposition of billirubin in the basal ganglia, pons, and cerebellum potentially fatal