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

1. Direct (conjugated, post- liver obstructive)
   1. congenital biliary atresia
   2. neuroblastoma
   3. cholesterol cysts
2. Cellular
   1. hepatitis
   2. galactosemia
   3. sepsis
   4. TORCHS
   5. tyrosinemia
   6. alpha 1 antitrypsis deficiency
3. Iindirect (unconjugated, pre-liver)
   1. sepsis
   2. hypotension
   3. 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

see http://bilitool.org/

Source

DONALDSON 10/07 (from UpToDate), Mistry, DeBonis