Neonatal Jaundice Carrie Phillipi, MD, PhD
Dec 17, 2015
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?