Neonatal jaundice: Difference between revisions
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*Acidosis | *Acidosis | ||
== | == Differential Diagnosis == | ||
===Common=== | |||
== | |||
*Physiologic | *Physiologic | ||
*Breast Milk Jaundice | *Breast Milk Jaundice | ||
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**Pt does not receive adequate oral intake | **Pt does not receive adequate oral intake | ||
***Results in reduced bowel movement/bilirubin excretion | ***Results in reduced bowel movement/bilirubin excretion | ||
Uncommon | ===Uncommon=== | ||
*Direct (conjugated, post- liver obstructive) | *Direct (conjugated, post- liver obstructive) | ||
**congenital biliary atresia | **congenital biliary atresia | ||
| Line 45: | Line 40: | ||
**G6PD Deficiency | **G6PD Deficiency | ||
**RBC membrane defects | **RBC membrane defects | ||
==Diagnosis== | |||
*See phototherapy chart (treatment section) for total bilirubin cutoff by age | |||
=== Work-Up === | |||
*Tbil/Dbil | |||
*CBC (for hemolytic anemia) | |||
*Coombs or T&S (mom & baby) | |||
== Treatment == | == Treatment == | ||
Revision as of 17:27, 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
Differential Diagnosis
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
Diagnosis
- See phototherapy chart (treatment section) for total bilirubin cutoff by age
Work-Up
- Tbil/Dbil
- CBC (for hemolytic anemia)
- Coombs or T&S (mom & baby)
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
Use total bilirubin
| 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: >=38wk + no risk factors
- Medium Risk: (>=38wk + risk factors) or (35-37 wk and no risk factors)
- High Risk: 35-37wk + risk factors