Neonatal jaundice: Difference between revisions
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==Background== | ==Background== | ||
* | *Neonatal jaundice can affect up to 84% of term newborns and is often a benign process that is quickly corrected once identified. It is also the most common cause for hospital readmission for neonates post birth.<ref>Sgro M, Campbell D, Shah V. Incidence and causes of severe neonatal hyperbilirubinemia in Canada. CMAJ. 2006;175(6):587–590.</ref> | ||
*The most important piece of the evaluation is distinguishing between unconjugated and conjugated [[hyperbilirubinemia]] since a conjugated (direct) hyperbilirubinemia is always pathologic and often more severe | |||
===Risk Factors=== | ===Risk Factors for Neonatal Jaundice=== | ||
*Isoimmune hemolytic disease | *Isoimmune hemolytic disease | ||
*G6PD deficiency | *G6PD deficiency | ||
| Line 16: | Line 16: | ||
==Clinical Features== | ==Clinical Features== | ||
*Jaundice | *Jaundice | ||
*Scleral icterus | |||
*Lethargy | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
== | ==Indirect (Unconjugated) Hyperbilirubinemia== | ||
''More common causes are listed first, followed by less common causes | |||
*Breast | *[[Breast milk jaundice]] | ||
**Due to substances in milk that | **Due to substances in milk that inhibits glucuronyl transferase. It may start as early as 3rd day and reaches peak by 3rd week of life. It is unlikely to cause kernicterus | ||
*[[Breast feeding jaundice]] | |||
**Patient does not receive adequate oral intake which then causes reduced bowel movement/bilirubin excretion. Best diagnosed by looking for signs of dehydration and comparing weight to birth weight. | |||
*Breast | *Blood group incompatibility: ABO, Rh factor, minor antigens | ||
**Patient does not receive adequate oral intake | *Diabetic mother/gestational diabetes | ||
*** | *Internal hemorrhage | ||
*Physiologic jaundice | |||
*Polycythemia | |||
*[[Sepsis]] | |||
*Hemoglobinopathies: thalassemia | |||
*Red blood cell enzyme defects: G6PD, pyruvate kinase | |||
*Red blood cell membrane disorders: spherocytosis, ovalocytosis | |||
*Hypothyroidism | |||
*[[Immune thrombocytopenic purpura]] | |||
*Mutations of glucuronyl transferase (i.e., Crigler-Najjar syndrome, Gilbert syndrome) | |||
*[[G6PD Deficiency]] | |||
=== | ===Direct (Conjugated) Hyperbilirubinemia=== | ||
''Conjugated bilirubinemia implies a hepatic or post hepatic cause. More common causes are listed first. | |||
*Hyperalimentation cholestasis | |||
*Neonatal [[hepatitis]] | |||
*Cytomegalovirus infection | |||
* | *[[Sepsis]] | ||
* | *TORCH infection | ||
* | *Biliary atresia | ||
*Cystic fibrosis | |||
** | *Hepatic infarction | ||
* | *Inborn errors of metabolism (e.g., galactosemia, tyrosinosis) | ||
* | |||
* | |||
==Evaluation== | ==Evaluation and Workup-Up== | ||
#See | ===Laboratory evaluation=== | ||
*Tbil/Dbil | |||
*CBC (for hemolytic anemia) | |||
*Consider coombs or T&S (mom & baby) | |||
===Evaluation=== | |||
#See [http://bilitool.info BiliTool] (treatment section) for total bilirubin cutoff by age | |||
#History extremely important | #History extremely important | ||
#*Mother's blood type (important if mother is RH negative or O blood type) | #*Mother's blood type (important if mother is RH negative or O blood type) | ||
#* | #*Assess for any signs of decreasing oral intake or signs of dehydration? | ||
#*Baby's general appearance (well appearing?) | #*Baby's general appearance (well appearing?) | ||
==Management== | ==Management== | ||
| Line 120: | Line 125: | ||
==External Links== | ==External Links== | ||
*[http://bilitool.org | *[http://bilitool.org BiliTool] | ||
==References== | ==References== | ||
<references/> | |||
[[Category:Pediatrics]] | [[Category:Pediatrics]] | ||
Revision as of 21:11, 25 October 2016
Background
- Neonatal jaundice can affect up to 84% of term newborns and is often a benign process that is quickly corrected once identified. It is also the most common cause for hospital readmission for neonates post birth.[1]
- The most important piece of the evaluation is distinguishing between unconjugated and conjugated hyperbilirubinemia since a conjugated (direct) hyperbilirubinemia is always pathologic and often more severe
Risk Factors for Neonatal Jaundice
- Isoimmune hemolytic disease
- G6PD deficiency
- Asphyxia
- Significant lethargy
- Temperature instability
- Sepsis
- Acidosis
- Prematurity
- Poor PO intake
Clinical Features
- Jaundice
- Scleral icterus
- Lethargy
Differential Diagnosis
Indirect (Unconjugated) Hyperbilirubinemia
More common causes are listed first, followed by less common causes
- Breast milk jaundice
- Due to substances in milk that inhibits glucuronyl transferase. It may start as early as 3rd day and reaches peak by 3rd week of life. It is unlikely to cause kernicterus
- Breast feeding jaundice
- Patient does not receive adequate oral intake which then causes reduced bowel movement/bilirubin excretion. Best diagnosed by looking for signs of dehydration and comparing weight to birth weight.
- Blood group incompatibility: ABO, Rh factor, minor antigens
- Diabetic mother/gestational diabetes
- Internal hemorrhage
- Physiologic jaundice
- Polycythemia
- Sepsis
- Hemoglobinopathies: thalassemia
- Red blood cell enzyme defects: G6PD, pyruvate kinase
- Red blood cell membrane disorders: spherocytosis, ovalocytosis
- Hypothyroidism
- Immune thrombocytopenic purpura
- Mutations of glucuronyl transferase (i.e., Crigler-Najjar syndrome, Gilbert syndrome)
- G6PD Deficiency
Direct (Conjugated) Hyperbilirubinemia
Conjugated bilirubinemia implies a hepatic or post hepatic cause. More common causes are listed first.
- Hyperalimentation cholestasis
- Neonatal hepatitis
- Cytomegalovirus infection
- Sepsis
- TORCH infection
- Biliary atresia
- Cystic fibrosis
- Hepatic infarction
- Inborn errors of metabolism (e.g., galactosemia, tyrosinosis)
Evaluation and Workup-Up
Laboratory evaluation
- Tbil/Dbil
- CBC (for hemolytic anemia)
- Consider coombs or T&S (mom & baby)
Evaluation
- See BiliTool (treatment section) for total bilirubin cutoff by age
- History extremely important
- Mother's blood type (important if mother is RH negative or O blood type)
- Assess for any signs of decreasing oral intake or signs of dehydration?
- Baby's general appearance (well appearing?)
Management
- Breast Milk Jaundice
- Do not need to routinely stop breast-feeding
- Treat with phototherapy when necessary
- Breast-Feeding Jaundice (Starvation Jaundice)
- Supplement with expressed breast milk or formula
- Exchange transfusion
- Consider if signs of bilirubin encephalopathy
- Hypertonia, arching, retrocollis, opisthotonos
- Consider if signs of bilirubin encephalopathy
Phototherapy Guidelines
| Age | Low Risk | Medium Risk | High Risk |
| Birth | 7.0 | 5.0 | 4.0 |
| 24h | 11.5 | 9.0 | 8.0 |
| 48h | 15 | 14 | 10 |
| 72h | 17.5 | 15 | 14 |
| 96h | 20 | 17.5 |
14.5 |
| 5+days | 21 | 17.5 | 15 |
- Low Risk: ≥38 weeks + no risk factors
- Medium Risk: (≥38 weeks + risk factors) or (35-37 weeks and no risk factors)
- High Risk: 35-37 weeks + risk factors
See Also
External Links
References
- ↑ Sgro M, Campbell D, Shah V. Incidence and causes of severe neonatal hyperbilirubinemia in Canada. CMAJ. 2006;175(6):587–590.