Neonatal jaundice occurs in 60 of term infants and 80 of preterm infants 1 and is caused by hyperbilirubinaemia that is unconjugated (divided into physiological or pathological) or conjugated (always pathological). Infection: sepsis, urinary tract infection, syphilis, toxoplasmosis, tuberculosis, hepatitis, rubella, herpes Metabolic disorder: alpha 1 antitrypsin deficiency, cystic fibrosis, galactosemia, glycogen storage disease, Gaucher's disease, hypothyroidism, Wilson's disease, Niemann-Pick diseaseĬhromosomal abnormality: Turner's syndrome, trisomy 18 and 21 syndromes Drugs: aspirin, acetaminophen, sulfa, alcohol, rifampin (Rifadin), erythromycin, corticosteroids, tetracyclineĬharacteristics: increased unconjugated bilirubin level, >6 percent reticulocytes, hemoglobin concentration of <13 g per dL (130 g per L)Ĭoombs' test positive: Rh factor incompatibility, ABO incompatibility, minor antigensĬoombs' test negative: red blood cell membrane defects (spherocytosis, elliptocytosis), red blood cell enzyme defects (G6PD deficiency, pyruvate kinase deficiency), drugs (e.g. Jaundice is the yellow colouring of skin and sclera caused by the accumulation of bilirubin in the skin and mucous membranes. The management goals are to exclude pathologic causes of hyperbilirubinemia and initiate treatment to prevent bilirubin neurotoxicity.Ĭharacteristics: increased unconjugated bilirubin level, normal percentage of reticulocytesĬharacteristics: increased unconjugated and conjugated bilirubin level, negative Coombs' test, conjugated bilirubin level of >2 mg per dL (34 μmol per L) or >20% of total serum bilirubin level, conjugated bilirubin in urineīiliary obstruction: biliary atresia, choledochal cyst, primary sclerosing cholangitis, gallstones, neoplasm, Dubin-Johnson syndrome, Rotor's syndrome Jaundice is considered pathologic if it presents within the first 24 hours after birth, the total serum bilirubin level rises by more than 5 mg per dL (86 mol per L) per day or is higher than 17 mg per dL (290 mol per L), or an infant has signs and symptoms suggestive of serious illness. Few term newborns with hyperbilirubinemia have serious underlying pathology. Phototherapy should be instituted when the total serum bilirubin level is at or above 15 mg per dL (257 mol per L) in infants 25 to 48 hours old, 18 mg per dL (308 mol per L) in infants 49 to 72 hours old, and 20 mg per dL (342 mol per L) in infants older than 72 hours. ![]() More recent recommendations support the use of less intensive therapy in healthy term newborns with jaundice. ![]() Historically, management guidelines were derived from studies on bilirubin toxicity in infants with hemolytic disease. Bilirubin levels with a deviation from the normal range and requiring intervention would be described as pathological jaundice (25). Hyperbilirubinemia is one of the most common problems encountered in term newborns.
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