Neonatal jaundice: Difference between revisions

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==Risk Factors==
== Background ==
#Isoimmune hemolytic disease
 
#G6PD deficiency
*Must distinguish between unconjugated and conjugated hyperbili
#Asphyxia
**Conjugated is always pathologic
#Significant lethargy
 
#Temperature instability
== Diagnosis ==
#Sepsis
 
#Acidosis
== 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


==Work-Up==
#Tbil/Dbil
#CBC (for hemolytic anemia)
#Coombs or T&S (mom & baby)
#?blood resorption
#?septic
#Decreased gastric motility
#Physiologic/breast milk (none @ birth presents 1st week)


==Phototherapy Guidelines==
 
== Phototherapy Guidelines ==


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| 15
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*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

  1. Tbil/Dbil
  2. CBC (for hemolytic anemia)
  3. Coombs or T&S (mom & baby)


DDx

  1. Breast Milk Jaundice
    1. Due to substances in milk that inhibit glucuronyl transferase
    2. May start as early as 3rd day, reaches peak by 3rd week of life
    3. Unlikely to cause kernicterus
  2. Breast-Feeding Jaundice (starvation jaundice)
    1. Pt does not receive adequate oral intake
      1. 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

  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. Indirect (unconjugated, pre-liver)
    1. sepsis
    2. hypotension
    3. 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

  1. Isoimmune hemolytic disease
  2. G6PD deficiency
  3. Asphyxia
  4. Significant lethargy
  5. Temperature instability
  6. Sepsis
  7. Acidosis


see http://bilitool.org/

Source

UpToDate