Neonatal jaundice: Difference between revisions
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== | == Background == | ||
# | |||
# | *Must distinguish between unconjugated and conjugated hyperbili | ||
# | **Conjugated is always pathologic | ||
# | |||
# | == Diagnosis == | ||
# | |||
# | == Work-Up == | ||
#Tbil/Dbil | |||
#CBC (for hemolytic anemia) | |||
#Coombs or T&S (mom & baby) | |||
== DDx == | |||
#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 | |||
== 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 | |||
== Disposition == | |||
== See Also == | |||
== Source == | |||
== Diagnosis == | == Diagnosis == | ||
#Direct (conjugated, post- liver obstructive) | #Direct (conjugated, post- liver obstructive) | ||
##congenital biliary atresia | ##congenital biliary atresia | ||
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##rH/ ABO incompatibility | ##rH/ ABO incompatibility | ||
==Phototherapy Guidelines== | |||
== Phototherapy Guidelines == | |||
{| cellpadding="1" cellspacing="1" width="200" border="1" | {| cellpadding="1" cellspacing="1" width="200" border="1" | ||
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| 15 | | 15 | ||
|} | |} | ||
*Use total bilirubin | |||
Low Risk: >=38wk + no risk factors | Low Risk: >=38wk + no risk factors | ||
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High Risk: 35-37wk + risk factors | High Risk: 35-37wk + risk factors | ||
see [http://bilitool.org/ <font color="#14456e">http://bilitool.org/</font>] | == Risk Factors == | ||
#Isoimmune hemolytic disease | |||
#G6PD deficiency | |||
#Asphyxia | |||
#Significant lethargy | |||
#Temperature instability | |||
#Sepsis | |||
#Acidosis | |||
<br/>see [http://bilitool.org/ <font color="#14456e">http://bilitool.org/</font>] | |||
== Source == | == Source == | ||
UpToDate | UpToDate | ||
[[Category:Peds]] | <br/>[[Category:Peds]] <br/><br/> |
Revision as of 22:43, 13 June 2011
Background
- Must distinguish between unconjugated and conjugated hyperbili
- Conjugated is always pathologic
Diagnosis
Work-Up
- Tbil/Dbil
- CBC (for hemolytic anemia)
- Coombs or T&S (mom & baby)
DDx
- 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
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
Disposition
See Also
Source
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
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 |
- Use total bilirubin
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
Risk Factors
- Isoimmune hemolytic disease
- G6PD deficiency
- Asphyxia
- Significant lethargy
- Temperature instability
- Sepsis
- Acidosis
Source
UpToDate