Neonatal jaundice
Background
- Must distinguish between unconjugated and conjugated hyperbili
- Conjugated is always pathologic
Diagnosis
Work-Up
- Tbil/Dbil
- CBC (for hemolytic anemia)
- Coombs or T&S (mom & baby)
DDx
- Breast Milk Jaundice
- Due to substances in milk that inhibit glucuronyl transferase
- May start as early as 3rd day, reaches peak by 3rd week of life
- Unlikely to cause kernicterus
- Breast-Feeding Jaundice (starvation jaundice)
- Pt does not receive adequate oral intake
- Results in reduced bowel movement/bilirubin excretion
- Pt does not receive adequate oral intake
Treatment
- Breast Milk Jaundice
- Do not need to routinely d/c breast-feeding
- Treat w/ phototherapy when necessary
- Breast-Feeding Jaundice
- Supplement with expressed breast milk or formula
Disposition
See Also
Source
Diagnosis
- Direct (conjugated, post- liver obstructive)
- congenital biliary atresia
- neuroblastoma
- cholesterol cysts
- Cellular
- hepatitis
- galactosemia
- sepsis
- TORCHS
- tyrosinemia
- alpha 1 antitrypsis deficiency
- Indirect (unconjugated, pre-liver)
- sepsis
- hypotension
- rH/ ABO incompatibility
Phototherapy Guidelines
Age | Low | Med | High |
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+day | 21 | 17.5 | 15 |
- Use total bilirubin
Low Risk: >=38wk + no risk factors
Med Risk: (>=38wk + risk factors) or (35-37 wk and no risk factors)
High Risk: 35-37wk + risk factors
Risk Factors
- Isoimmune hemolytic disease
- G6PD deficiency
- Asphyxia
- Significant lethargy
- Temperature instability
- Sepsis
- Acidosis
Source
UpToDate