Neonatal jaundice: Difference between revisions
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***Hypertonia, arching, retrocollis, opisthotonos | ***Hypertonia, arching, retrocollis, opisthotonos | ||
== Phototherapy Guidelines == | === Phototherapy Guidelines === | ||
''Use total bilirubin'' | |||
{| | {| class="wikitable" | ||
|- | |- | ||
| Age | | '''Age''' | ||
| Low | | '''Low Risk''' | ||
| | | '''Medium Risk''' | ||
| High | | '''High Risk''' | ||
|- | |- | ||
| Birth | | Birth | ||
| Line 92: | Line 92: | ||
|- | |- | ||
| 5+ | | 5+days | ||
| 21 | | 21 | ||
| 17.5 | | 17.5 | ||
| Line 98: | Line 98: | ||
|} | |} | ||
* | *Low Risk: >=38wk + no risk factors | ||
*Medium Risk: (>=38wk + risk factors) or (35-37 wk and no risk factors) | |||
Low Risk: >=38wk + no risk factors | *High Risk: 35-37wk + risk factors | ||
High Risk: 35-37wk + risk factors | |||
;See [http://bilitool.org/ <font color="*14456e">http://bilitool.org/</font>] | |||
== References == | == References == | ||
[[Category:Peds]] | [[Category:Peds]] | ||
Revision as of 17:25, 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
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