Neonatal Jaundice and Constipation in Pediatrics

Neonatal Jaundice

• Physiologic jaundice of the newborn is a common and benign cause of indirect hyperbilirubinemia on days 2-4 of life.
• It occurs due to increased bilirubin production, decreased bilirubin clearance, and increased enterohepatic recycling.

Constipation

• Functional constipation is common in toddlers due to transition to solid food and cow's milk, toilet training, and school entry.
• Initial treatment involves dietary changes and laxatives (e.g., polyethylene glycol) to soften stools.

Congenital and Developmental Anomalies

Biliary Atresia

• Biliary atresia is characterized by fibrotic obliteration of the extrahepatic bile duct.
• It presents at age 2-8 weeks with direct hyperbilirubinemia (e.g., jaundice, acholic stools, dark urine).
• Liver biopsy is necessary for diagnosis, showing intrahepatic bile duct proliferation and portal tract inflammation.

Meckel Diverticulum

• Meckel diverticulum often presents in young toddlers as painless lower gastrointestinal bleeding without abdominal pain, diarrhea, or vomiting.
• Diagnosis is made using a technetium-99m pertechnetate scan, which identifies ectopic gastric mucosa.
• Meckel diverticulum is the most common pathologic lead point in cases of recurrent intussusception, particularly in atypical locations (e.g., small bowel).

Tracheoesophageal Fistula

• Tracheoesophageal fistula with esophageal atresia presents shortly after birth with copious oral secretions and choking, coughing, and/or vomiting with feeding.
• Diagnosis can be confirmed by inserting a nasogastric tube, which encounters resistance at the proximal esophageal pouch.

Umbilical Hernia

• A congenital umbilical hernia is typically soft and reducible and does not require intervention.
• These hernias usually close spontaneously by age 5.

Learn about the causes and treatments of physiologic jaundice in newborns and functional constipation in toddlers, including bilirubin production and clearance, dietary changes, and laxative use.