Neonatal jaundice
Risk Factors:
1) Isoimmune hemolytic disease
2) G6PD deficiency
3) Asphyxia
4) Significant lethargy
5) Temperature instability
6) Sepsis
7) Acidosis
8) Albumin <3 g/d (if measured)
Diagnosis
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
Work-Up
1) Tbil
2) Dbil
3) CBC (for hemolytic anemia)
4) Coombs or T&S (mom & baby)
5) ?blood resorption
6) ?septic
7) ?Decreased gastric motility
8) Physiologic/breast milk (none @ birth presents 1st week)
PHOTOTHERAPY GUIDELINES
| Age | Low | Med | High |
| 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 |
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
Source
DONALDSON 10/07 (from UpToDate), Mistry, DeBonis