Neonatology Book

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Nonphysiologic Neonatal JaundiceAka: Non-physiologic Neonatal Hyperbilirubinemia

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  1. See Also
    1. Neonatal Jaundice
  2. Criteria
    1. Jaundice in first 24 hours of life
    2. Serum Bilirubin rises > 5 mg/dl in the first 24 hours
    3. Direct Bilirubin (conjugated) >2mg/dl
    4. Term Infant
      1. Serum Bilirubin >17 mg/dl
      2. Jaundice persists longer than 1 week
        1. Except in Breast Feeding Jaundice
    5. Preterm Infant
      1. Serum Bilirubin >15 mg/dl
      2. Jaundice persist longer than 2 weeks
        1. Except in Breast Feeding Jaundice
  3. Causes
    1. See Neonatal Jaundice Causes
  4. Risk Factors for Severe Hyperbilirubinemia
    1. Jaundice in first 24 hours (always pathologic)
    2. Preterm gestation earlier than 38 weeks
    3. Male gender
    4. Maternal age over 25 years old
    5. East Asian or Native American ethnicity
    6. Significant Birth Trauma
      1. Cephalohematoma
      2. Large hematomas
    7. Infant breast feeds only
    8. ABO or Rh incompatibility
    9. Maternal Gestational Diabetes
    10. Polycythemia
    11. Medication exposure
      1. Mother: Diazepam, Oxytocin
      2. Infant: Pediazole, Chloramphenicol
  5. Signs
    1. Prematurity
    2. Small for Gestational Age
      1. Polycythemia
      2. Intrauterine Growth Retardation (TORCH Infection)
    3. Microcephaly
      1. Intrauterine Growth Retardation (TORCH Infection)
    4. Extravascular blood
      1. Bruising
      2. Cephalohematoma
    5. Pallor
      1. Hemolytic Anemia
      2. Extravascular blood loss
    6. Petechiae
      1. Congenital infection (TORCH Infection)
      2. Sepsis
      3. Erythroblastosis Fetalis
    7. Hepatomegaly or Splenomegaly
      1. Hemolytic Anemia
      2. Congenital infection (TORCH Infection)
      3. Liver disease
    8. Omphalitis
    9. Chorioretinitis
      1. Congenital infection (TORCH Infection)
    10. Hypothyroidism signs
  6. Labs
    1. Complete Blood Count with platelets
    2. Reticulocyte Count
    3. Peripheral Smear
    4. Coombs Test Positive
      1. Rhesus Incompatibility (CDE)
        1. anti-D (most severe)
        2. anti-C
        3. anti-E
      2. ABO incompatibility
        1. A hemolysins
        2. B hemolysins
      3. Anti-Duffy
      4. Anti-Kell
  7. Evaluation
    1. Term newborn with Jaundice onset Day 1 or after Day 14
      1. See Neonatal Jaundice Causes
    2. Term newborn with Jaundice onset 1 to 14 days of life
      1. Conjugated Bilirubin >2 mg/dl
        1. Suggests biliary obstruction
        2. See Direct Hyperbilirubinemia
        3. See Neonatal Jaundice Causes
      2. Increased Hemoglobin
        1. Polycythemia
      3. Abnormal Peripheral Smear
        1. Observe for Hemolytic Anemia
      4. Normal Peripheral Smear
        1. See Neonatal Jaundice Causes
        2. Consider decreased conjugation causes
        3. Consider non-hemolytic increased Bilirubin load
  8. Resources
    1. Bilirubin Tool
      1. http://www.bilitool.com
  9. Management
    1. Consider Phototherapy
    2. Consider Exchange Transfusion
  10. Complications
    1. Congenital Anemia (Mild Hemolysis)
      1. Pale
      2. Hemoglobin of 13 to 15
      3. Few Reticulocytes
      4. Slight Hepatomegaly and Splenomegaly
      5. No Urobilinogen
    2. Icterus Gravis (Severe Hemolysis)
      1. Jaundice at birth
      2. Anemia
      3. Large Hepatomegaly and Splenomegaly
      4. Urobilinogen positive
    3. Kernicterus
  11. References
    1. (2001) Pediatrics 108(3):763
      1. AAP position on Neonatal Jaundice and Kernicterus
    2. Porter (2002) Am Fam Physician 65(4):599
      1. Review of Neonatal Hyperbilirubinemia

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