Neonatal Jaundice: quick review

3 Aug

HUGE differential considerations for neonatal jaundice including hemolytic, infectious, obstructive, metabolic

Physiologic jaundice of the newborn

  • occurs in 60% during first week of life, making it the most common cause
  • Gradual increase bili with peak of 6mg/dL on day 3 of life then decline to normal levels within 2 weeks

Breast milk jaundice

  • the 2nd most common cause
  • bili levels peak at 10 days to 3 wks of life
  • may persist up to 10 weeks

Indications for workup (e.g. CBC, chemistries, UA, ammonia):

Jaundice within 24 hours of birth

-Elevated direct biirubin (>2mg/dL or >20% total bili)

-Jaundice persisting beyond 3 weeks old

-Rapidly rising total serum bilirubin

-Toxic appearing infant

Most worrisome outcome of toxic levels of bilirubin is kernicterus (yellow staining in areas of the brain which may lead to residual neurologic problems)

Two main treatments = phototherapy and exchange transfusion

 

•Breast-feeding may continue and supplemented with formula prn unless infant is severely jaundiced

•Phototherapy now available on outpatient basis

Hospital admission for total bilirubin > 18-20 mg/dL and for all with direct hyperbilirubinemia

Submitted by F. DiFranco.

Reference(s): Et al. Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation. Pediatrics. July 1, 2004; 114(1):297 -316; Marx, et al. Neonatal jaundice. Rosen’s Emergency Medicine. Chapter 170: Gastrointestinal disorders. 2010. 7th ed. 2168-2171.; picture from first article.

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One Response to “Neonatal Jaundice: quick review”

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  1. Neonatal Jaundice: Treatment Strategies | DAILYEM - March 11, 2013

    […] Nice review post on Aug 3 by F. DiFranco covers causes and indications for work up. […]

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