neonatal jaundice
| Affects up to 60% infants and 80% of prems in first week of life! | |
|---|---|
| History | Speed of onset: - <24h = pathological (and hopefully picked up by routine screening) - 24h to <14d (term baby) = probably physiological Family history - sibling requiring phototherapy birth trauma, cephalhaematoma FHx Hbpathy |
| Examination | Look out for underlying pathology: MAGGIE - organomegaly (massive organs) - dehydration (a bit dry) - genetic conditions - GI/biliary obstruction - infection/sepsis (as always) - encephalopathy |
| Diagnostic investigations | - Transcutaneous bilirubin - only for gestation >35/40, >24h of life - Serum bilirubin is still gold standard - NO EYEBALLING >:( To investigate further: Total and ‘split’ bilirubin → mandatory if jaundice lasts >14d Full blood count and film Reticulocyte count Direct Coombs test Thyroid function tests Need to check for G6PD deficiency? |
| Differentials | |
| Management | Start treatment before serum bilirubin results if: - transcut bilirubin is very high - or rate of rise will bring bilirubin over treatment line in the next 6h - Phototherapy - IVIG for rhesus or ABO haemolytic disease - Exchange transfusion if encephalopathy present |
etiology
| Unconjugated bilirubin = blood problem | Conjugated bilirubin = HPB problem |
|---|---|
| - ↑ RBCs - polycythaemia - ↑ destruction of RBCs - haemolysis - ABO incompatibility, G6PD - drug induced - penicillame - sepsis - extravasation of blood - cephalhaematoma - endocrine - hypothyroid, galactosemia - ↑ enterohepatic circulation (↓ gastrointestinal transit) - breast milk jaundice - ↓ bilirubin binding - drugs - gentamicin, penicillin - acidosis - hypoxia, hypothermia, hypoglycaemia - ↓ conjugation - congenital causes |
- hepatocellular - shock - infections - CMV... - genetic conditions - intrahepatic - extrahepatic - biliary atresia |
breast milk jaundice
- the child is well AND
- day 3-5, last beyond day 10
bilirubin testing thresholds
- If the rate of total serum bilirubin is ≥5 micromol/L (≥0.3 mg/dL) per hour in the first 24 hours or ≥3 micromol/L (≥0.2 mg/dL) per hour thereafter, high risk of ↑ bilirubin