Updated: 9/22/2018

Neonatal Jaundice

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Snap Shot
  • A two-week-old, healthy, fullterm infant is slightly jaundiced. Labs show a total bilirubin of 18 mg/dl (<7 mg/dl), and a direct bilirubin of .8 mg/dl (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
Evaluation
  • Labs
    • elevated direct and total bilirubin
Treatment
  • Physiologic jaundice requires no treatment
  • Phototherapy
    • water solublizes unconjugated bilirubin, allowing for renal excretion
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
 

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