Neonatal jaundice
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
Differential Diagnosis
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
Diagnosis
- See phototherapy chart (treatment section) for total bilirubin cutoff by age
Work-Up
- Tbil/Dbil
- CBC (for hemolytic anemia)
- Coombs or T&S (mom & baby)
Treatment
- Breast Milk Jaundice
- Do not need to routinely stop breast-feeding
- Treat with phototherapy when necessary
- Breast-Feeding Jaundice (Starvation 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