Neonatal Jaundice

Carrie Phillipi, MD, PhD

Newborn with Jaundice

Neonatal Jaundice Definitions

Physiologic Pathologic Indirect (unconjugated) Direct (conjugated) Breast feeding jaundice Breast milk jaundice

Production of Bilirubin

Conjugation of Bilirubin

Problems at the level of the RBC

Hemolysis (ABO, Rh, minor antigens) Hemolysis (Enzyme Deficits--G6PD

deficiency) Bruising Cephalohematoma Increased Load (polycytemia) Membrane Defects

Direct and Indirect Coombs

Problems at the level of the LIVER

Sluggish enzyme (UGT 1A1) Crigler-Najjar (rare) Gilbert’s (rare)

Direct hyperbilirubinemia (always pathologic)

Problems at the level of the GUT

Poor feeding Obstruction Infant of a diabetic mother

The entero-hepatic circulation kicks in!

Generic Problems

Prematurity Serious Infections Sepsis Hypoalbuminemia

Jaundice on at 96 hours

A term baby is noted to be jaundiced to the hips at 96 hours of life. Mother is AB+/Ab-, her milk is in and baby is feeding well with transitional stools.

What is your next step?

Hyperbilirubinemia—risk stratification

Risk factors for jaundice

Blood Group Incompatibility or knownHemolytic Disease (G6PD deficiency)

East Asian Race

Exclusive Breastfeeding

Previous sibling who received phototherapy

Jaundice in the first 24 hours

Bruising

Cehalohematoma

Guidelines for Phototherapy

Kernicterus

Jaundice at 12 hours

A term baby born by SVD with apgars of 8,9 is noted to have jaundice to the chest at 12 hours of life. Mother is O+/Ab-. Baby is vigorous and well-appearing.

What is your next step?

Phototherapy

Transcutaneous Bilirubinometer

Jaundice at 72 hours

Well-appearing near term (37 week) infant born to O+/Ab- mother is noted to be jaundiced to the hips at 72 hours.

What is your next step?