05 Neonatal Jaundice
Last updated
Last updated
Prehepatic: mostly unconjugated
Hemolysis: coombs, G6PD, pyruvate etc.
Hemorrhage: cephalohematoma
Neonate: also twin-twin transfusion
Breast milk, breast feeding
Posthepatic: mostly conjugated. Usually means gallstones/cancer in adults but not in kids
Biliary atresia
Sepsis
Metabolic derrangements
Intrahepatic: mixed picture. Genetic diseases
Criglar Najar: looks like prehepatic
Gilbert: looks like prehepatic
Dubin Johnson: looks like post hepatic
Rotor: looks like posthepatic
Hepatitis: damage to liver
Direct bilirubin aka conjugated:
has charge, water soluble, cannot cross cell membrane
when excreted in urine: trapped in urine, turn urine dark
cannot cross BBB: no kernicterus
Indirect bilirubin aka unconjugated:
fat soluble. Not cross glomerulus and not excreted in urine
Does not turn urine dark
Can cross BBB: kernicterus
Overwhelming normal system with rate limiting conjugation. Takes time to develop. By the time for first visit, not yellow anymore
onset: after 72 hours. Leaves newborn nursery, turn yellow
resolution: < 1wk. < 2 wk for premature
bilirubin: unconjugated
rise: < 5 / day
Atresia, sepsis, metabolic problems. Something is wrong
onset: first day
resolution: won't resolve by self
bilirubin: conjugated
rise: > 5 / day
Only works for unconjugated bilirubin. For physiologic jaundice, help baby move bilirubin along. Pathologic jaundice requires surgery.
High bili: convert unconjugated to conjugated via blue box
Really high bili: exchange transfusion
path: low quantity, bowel function low, bilirubin sits in colon and reabsorbed
pt: day 1-7, unconjug bili
treatment: feed more
path: enzyme in maternal milk inhibits conjugation
pt: > day 7, unconjug bili
treatment: hydrolyzed formula
