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What is the normal appearance time of physiological jaundice?
What is the normal appearance time of physiological jaundice?
What is the rate of increase in bilirubin in pathological jaundice?
What is the rate of increase in bilirubin in pathological jaundice?
What is the level of serum bilirubin in pathological jaundice?
What is the level of serum bilirubin in pathological jaundice?
What is the duration of jaundice in pathological jaundice?
What is the duration of jaundice in pathological jaundice?
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What is a common cause of jaundice that should be considered until proven otherwise?
What is a common cause of jaundice that should be considered until proven otherwise?
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What is the typical peak time for bilirubin levels in breast milk jaundice?
What is the typical peak time for bilirubin levels in breast milk jaundice?
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What is the characteristic of stool in pathological jaundice?
What is the characteristic of stool in pathological jaundice?
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What is a characteristic of physiological jaundice?
What is a characteristic of physiological jaundice?
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What is the level of direct bilirubin in pathological jaundice?
What is the level of direct bilirubin in pathological jaundice?
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What is a possible reason for the development of physiological jaundice?
What is a possible reason for the development of physiological jaundice?
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What is the cause of hemolytic disease of the newborn?
What is the cause of hemolytic disease of the newborn?
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What is the neurological complication of unconjugated bilirubinemia?
What is the neurological complication of unconjugated bilirubinemia?
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What is a feature of pathological jaundice?
What is a feature of pathological jaundice?
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What is a possible cause of jaundice that appears within the first 24 hours?
What is a possible cause of jaundice that appears within the first 24 hours?
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What is the typical bilirubin level in breast milk jaundice?
What is the typical bilirubin level in breast milk jaundice?
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What happens to bilirubin levels in breast milk jaundice if nursing is interrupted for 24 hours?
What happens to bilirubin levels in breast milk jaundice if nursing is interrupted for 24 hours?
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What is the normal range of total serum bilirubin in adults?
What is the normal range of total serum bilirubin in adults?
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What is the definition of direct hyperbilirubinemia?
What is the definition of direct hyperbilirubinemia?
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What is the main cause of jaundice in neonates?
What is the main cause of jaundice in neonates?
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What is the characteristic of unconjugated bilirubin?
What is the characteristic of unconjugated bilirubin?
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What is the primary goal of treating neonatal jaundice?
What is the primary goal of treating neonatal jaundice?
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What is the clinical presentation of jaundice in neonates?
What is the clinical presentation of jaundice in neonates?
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What is the level of total serum bilirubin at which clinical jaundice is seen in neonates?
What is the level of total serum bilirubin at which clinical jaundice is seen in neonates?
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What is the primary aim of early feeding and adequate hydration in physiologic jaundice?
What is the primary aim of early feeding and adequate hydration in physiologic jaundice?
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What is the initial step in the workup for pathologic hyperbilirubinemia?
What is the initial step in the workup for pathologic hyperbilirubinemia?
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What is the characteristic of conjugated bilirubin?
What is the characteristic of conjugated bilirubin?
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What is the treatment for chronic cholestasis?
What is the treatment for chronic cholestasis?
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What is the most common type of hyperbilirubinemia?
What is the most common type of hyperbilirubinemia?
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What is the result of kernicterus in most cases?
What is the result of kernicterus in most cases?
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What is the purpose of performing a G6PD assay?
What is the purpose of performing a G6PD assay?
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Study Notes
Neonatal Jaundice
- Neonatal hyperbilirubinemia: elevated serum bilirubin level in the neonate
- Pathophysiology: increased production of bilirubin from breakdown of fetal red blood cells, immaturity of hepatic conjugation, and elimination in the first week of life
Types of Hyperbilirubinemia
- Indirect hyperbilirubinemia: increased unconjugated bilirubin, the most common type
- Direct hyperbilirubinemia: conjugated bilirubin (with glucuronide), defined as direct bilirubin >2 mg/dL
Bilirubin Metabolism
- Types of bilirubin:
- Unconjugated bilirubin (indirect): binds to albumen, fat soluble, can cross blood-brain barrier, toxic in high levels
- Conjugated bilirubin (direct): conjugated with glucoronic acid, water soluble, excreted in urine and stool, not toxic
Jaundice
- Yellowish discoloration of skin, conjunctiva, and mucous membranes
- Normal total serum bilirubin (TSB) = 0.1-0.8 mg/dL
- Clinical jaundice in adults: TSB > 2 mg/dL
- Clinical jaundice in neonates: TSB > 7 mg/dL
Etiology of Jaundice
- Rh and ABO incompatibilities
- Cephalhematoma
- Intrauterine infection: TORCH (toxoplasmosis, rubella, cytomegalovirus, herpes simplex)
- Neonatal sepsis
- Physiological jaundice
- Familial non-hemolytic icterus (Crigler-Najjar syndrome)
- Neonatal hepatitis
- Biliary atresia
- Breast milk jaundice
- Hypothyroidism
- Spherocytosis
- Red cells enzyme defects (e.g. G6PD deficiency)
Physiological Jaundice
- Characteristics:
- Appears after 24 hours
- Total bilirubin rises by less than 5 mg/dL per day
- Maximum intensity by 4th-5th day in term
- Serum level less than 13 mg/dL
- Clinically not detectable after 10 days
- Infants are healthy
- Why it develops: increased bilirubin load, defective conjugation, and increased entero-hepatic circulation
Breast Milk Jaundice
- Bilirubin peaks at 2nd-3rd week
- Unconjugated bilirubin level: 10-30 mg/dL
- If nursing is interrupted for 24 hours, the bilirubin level falls quickly
Difference between Physiological and Pathological Jaundice
- Pathological jaundice:
- Appears within 24 hours of age
- Increase of bilirubin > 5 mg/dL per day
- Serum bilirubin > 13 mg/dL
- Jaundice persisting after 14 days
- Stool clay/white colored and urine staining yellow clothes
- Direct bilirubin > 2 mg/dL
Hemolytic Disease of the Newborn
- Rh isoimmunization
- ABO incompatibility
- Mother's circulating antibodies causing hemolytic disease in the baby
Pathological Jaundice
- Unconjugated bilirubin: hemolytic disease
- Conjugated bilirubin: hepatic, posthepatic, and idiopathic neonatal hepatitis
Kernicterus (Bilirubin Encephalopathy)
- Unconjugated bilirubin passes the blood-brain barrier and is deposited in the brain
- Occurs when unconjugated bilirubin levels > 20 mg/dL in term infants
- Clinical manifestations: poor feeding, lethargy, hypotonia, convulsions, bulging fontanel, and hypertonicity
- Usually ends in death or leaves survivors with choreoathetoid, palsy, mental retardation, or nerve deafness
Laboratory Tests
- Total and direct bilirubin
- Blood group and Rh for mother and baby
- Hematocrit, retic count, and peripheral smear
- G6PD assay
- Coomb's test
- Sepsis screen
- Liver function tests
- TORCH titers
- Liver scan when conjugated hyperbilirubinemia
- Ultrasonography of the liver and bile ducts in cholestasis
Management of Neonatal Jaundice
- Treatment of neonatal jaundice:
- Correct the etiologic condition
- Bring down the level of serum bilirubin to prevent kernicterus
- Treatment options:
- Phototherapy
- Intravenous immune globulin (IVIG)
- Exchange transfusion
- Treatment of chronic cholestasis
Treatment of Chronic Cholestasis
- Use of medium chain triglyceride formula
- Replacement of fat-soluble vitamins
- Micronutrients
- Liver transplantation
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Description
This quiz covers the definition and types of jaundice, metabolism of bilirubin, causes and management of neonatal jaundice, and pathophysiology of neonatal hyperbilirubinemia.
