Neonatal Indirect Hyperbilirubinemia UCI-CHOC Medical Student Lectures
Neonatal Indirect Hyperbilirubinemia
Apr 10, 2023
Largest amount comes from breakdown of heme
• Unconjugated bili -> conjugated bili in liver
• Not only breaks down more RBC than adults as
newborn (remember, tend to be polycythemic), but
also has impaired secretion
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• 95%tile on Bhutani nomogram
• Severe: Total bili >25, or if rate of rise >0.2mg/dL/hour
• Direct Hyperbilirubinemia: >1 if total bili <5, or more
than 20% of total bili
• Peak usually occurs 48 to 96 hours of age in
Caucasians/African Americans, typically 7-9mg/dL
• Peak usually occurs 72 to 120 hours of age in East
Asians, and is comparatively higher at 10-14mg/dL
Transcript
Neonatal Hyperbilirubinemia• Unconjugated bili -> conjugated bili in liver
• Not only breaks down more RBC than adults as
newborn (remember, tend to be polycythemic), but
also has impaired secretion
When is it Bad?
• Severe: Total bili >25, or if rate of rise >0.2mg/dL/hour
• Direct Hyperbilirubinemia: >1 if total bili <5, or more
than 20% of total bili
• Peak usually occurs 48 to 96 hours of age in
Caucasians/African Americans, typically 7-9mg/dL
• Peak usually occurs 72 to 120 hours of age in East
Asians, and is comparatively higher at 10-14mg/dL
Jaundice Risk Factors
Causes of Indirect
• Immune mediated: ABO/Rh incompatibility
• RBC enzyme defects (G6PD, pyruvate kinase deficiency)
• Sepsis
due to weight loss, fluid loss
• Can also cause
• Typically resolves by 12
Treatment
Phototherapy
• Results in decline of TB at least 2-3mg/dL within 4-6 hours
• Photons emitted by blue to green light convert bilirubin into forms that can be excreted by bile/urine without conjugation
• Important to maintain hydration!
• Discharge when total bili 12- 14mg/dL, consider checking rebound if underlying hemolytic process
Exchange Transfusion
• Much higher risk of complication: Thrombocytopenia, coagulopathy, GVHD, NEC, portal vein thrombosis, electrolyte abnormalities, cardiac arrhythmias
Reference: Pediatrics, Vol. 114, Pages 297-316
Resources
• Pan DH, Rivers Y. Jaundice: Newborn to Age 2 Months. Pediatrics In Review.
• Not only breaks down more RBC than adults as
newborn (remember, tend to be polycythemic), but
also has impaired secretion
When is it Bad?
• Severe: Total bili >25, or if rate of rise >0.2mg/dL/hour
• Direct Hyperbilirubinemia: >1 if total bili <5, or more
than 20% of total bili
• Peak usually occurs 48 to 96 hours of age in
Caucasians/African Americans, typically 7-9mg/dL
• Peak usually occurs 72 to 120 hours of age in East
Asians, and is comparatively higher at 10-14mg/dL
Jaundice Risk Factors
Causes of Indirect
• Immune mediated: ABO/Rh incompatibility
• RBC enzyme defects (G6PD, pyruvate kinase deficiency)
• Sepsis
due to weight loss, fluid loss
• Can also cause
• Typically resolves by 12
Treatment
Phototherapy
• Results in decline of TB at least 2-3mg/dL within 4-6 hours
• Photons emitted by blue to green light convert bilirubin into forms that can be excreted by bile/urine without conjugation
• Important to maintain hydration!
• Discharge when total bili 12- 14mg/dL, consider checking rebound if underlying hemolytic process
Exchange Transfusion
• Much higher risk of complication: Thrombocytopenia, coagulopathy, GVHD, NEC, portal vein thrombosis, electrolyte abnormalities, cardiac arrhythmias
Reference: Pediatrics, Vol. 114, Pages 297-316
Resources
• Pan DH, Rivers Y. Jaundice: Newborn to Age 2 Months. Pediatrics In Review.
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