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Updated: Nov 8 2020

Neonatal Jaundice

  • 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
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