Neonatal jaundice: Difference between revisions
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*Must distinguish between unconjugated and conjugated hyperbili | *Must distinguish between unconjugated and conjugated hyperbili | ||
**Conjugated is always pathologic | **Conjugated is always pathologic | ||
=== Risk Factors === | |||
*Isoimmune hemolytic disease | |||
*G6PD deficiency | |||
*Asphyxia | |||
*Significant lethargy | |||
*Temperature instability | |||
*Sepsis | |||
*Acidosis | |||
== Work-Up == | == Work-Up == | ||
*Tbil/Dbil | |||
*CBC (for hemolytic anemia) | |||
*Coombs or T&S (mom & baby) | |||
== DDx == | == DDx == | ||
Common | Common | ||
*Physiologic | |||
*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 | |||
Uncommon | Uncommon | ||
*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 | |||
**G6PD Deficiency | |||
**RBC membrane defects | |||
== Treatment == | == Treatment == | ||
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== Phototherapy Guidelines == | == Phototherapy Guidelines == | ||
See [http://bilitool.org/ <font color=" | See [http://bilitool.org/ <font color="*14456e">http://bilitool.org/</font>] | ||
{| cellpadding="1" cellspacing="1" width="200" border="1" | {| cellpadding="1" cellspacing="1" width="200" border="1" | ||
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High Risk: 35-37wk + risk factors | High Risk: 35-37wk + risk factors | ||
== | |||
== References == | |||
[[Category:Peds]] | [[Category:Peds]] | ||
Revision as of 17:21, 10 May 2015
Background
- Must distinguish between unconjugated and conjugated hyperbili
- Conjugated is always pathologic
Risk Factors
- Isoimmune hemolytic disease
- G6PD deficiency
- Asphyxia
- Significant lethargy
- Temperature instability
- Sepsis
- Acidosis
Work-Up
- Tbil/Dbil
- CBC (for hemolytic anemia)
- Coombs or T&S (mom & baby)
DDx
Common
- Physiologic
- 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
Uncommon
- Direct (conjugated, post- liver obstructive)
- congenital biliary atresia
- neuroblastoma
- cholesterol cysts
- Cellular
- Indirect (unconjugated, pre-liver)
- sepsis
- hypotension
- rH/ABO incompatibility
- G6PD Deficiency
- RBC membrane defects
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
- Exchange transfusion
- Consider if signs of bilirubin encephalopathy
- Hypertonia, arching, retrocollis, opisthotonos
- Consider if signs of bilirubin encephalopathy
Phototherapy Guidelines
| Age | Low risk pt cut-off | Med risk pt cut-off | High risk pt cut-off |
| 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