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Transcript of Neonatal Jaundice
Neonatal JaundiceCarrie Phillipi, MD, PhDNewborn with Jaundice
Neonatal Jaundice DefinitionsPhysiologicPathologicIndirect (unconjugated)Direct (conjugated)Breast feeding jaundiceBreast milk jaundiceProduction of Bilirubin
Conjugation of Bilirubin
Problems at the level of the RBCHemolysis (ABO, Rh, minor antigens)Hemolysis (Enzyme Deficits--G6PD deficiency)BruisingCephalohematomaIncreased Load (polycytemia)Membrane DefectsDirect and Indirect Coombs
Problems at the level of the LIVERSluggish enzyme (UGT 1A1)Crigler-Najjar (rare)Gilberts (rare)
Direct hyperbilirubinemia (always pathologic)Problems at the level of the GUTPoor feedingObstructionInfant of a diabetic mother
The entero-hepatic circulation kicks in!Generic ProblemsPrematuritySerious InfectionsSepsisHypoalbuminemiaJaundice on at 96 hoursA 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?Hyperbilirubinemiarisk stratification
Risk factors for jaundice
Blood Group Incompatibility or knownHemolytic Disease (G6PD deficiency)East Asian RaceExclusive BreastfeedingPrevious sibling who received phototherapyJaundice in the first 24 hoursBruisingCehalohematomaGuidelines for Phototherapy
Jaundice at 12 hoursA 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
Jaundice at 72 hoursWell-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?