Neonatal jaundice: Difference between revisions
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*Prematurity | *Prematurity | ||
*Poor PO intake | *Poor PO intake | ||
==Clinical Features== | |||
*Jaundice | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
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**Patient does not receive adequate oral intake, best diagnosed by looking for signs of dehydration and comparing weight to birth weight | **Patient does not receive adequate oral intake, best diagnosed by looking for signs of dehydration and comparing weight to birth weight | ||
***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) | ||
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**[[hypotension]] | **[[hypotension]] | ||
**rH/ABO incompatibility | **rH/ABO incompatibility | ||
**G6PD Deficiency | **[[G6PD Deficiency]] | ||
**RBC membrane defects | **RBC membrane defects | ||
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*Tbil/Dbil | *Tbil/Dbil | ||
*CBC (for hemolytic anemia) | *CBC (for hemolytic anemia) | ||
* | *Consider coombs or T&S (mom & baby) | ||
==Management== | ==Management== | ||
Revision as of 23:06, 22 October 2016
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
- Prematurity
- Poor PO intake
Clinical Features
- Jaundice
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)
- Patient does not receive adequate oral intake, best diagnosed by looking for signs of dehydration and comparing weight to birth weight
- Results in reduced bowel movement/bilirubin excretion
- Patient does not receive adequate oral intake, best diagnosed by looking for signs of dehydration and comparing weight to birth weight
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
Evaluation
- See phototherapy chart (treatment section) for total bilirubin cutoff by age
- History extremely important
- Mother's blood type (important if mother is RH negative or O blood type)
- PO intake, signs of dehydration?
- Baby's general appearance (well appearing?)
Work-Up
- Tbil/Dbil
- CBC (for hemolytic anemia)
- Consider coombs or T&S (mom & baby)
Management
- Breast Milk Jaundice
- Do not need to routinely stop breast-feeding
- Treat with phototherapy when necessary
- Breast-Feeding Jaundice (Starvation 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 | 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: ≥38 weeks + no risk factors
- Medium Risk: (≥38 weeks + risk factors) or (35-37 weeks and no risk factors)
- High Risk: 35-37 weeks + risk factors