Neonatal Jaundice

Snap Shot

• A two-week-old, healthy, full-term infant is slightly jaundiced. Labs show a total bilirubin of 18 mg/dl (<7 mg/dl) and a direct bilirubin of 0.8 mg/dl (0-0.4 mg/dl).

Introduction

• May be physiologic or pathologic
• Physiologic jaundice
  • occurs between days 3-5 and is clinically benign
    • indirect (unconjugated) billirubin rise
  • occur in 50% of neonates during first week of life
  • results from
    • increased bilirubin production due to degradation of HbF
    • relative deficiency in glucuronyl transferase in immature liver
• Pathologic jaundice
  • jaundice in the first day of life is always pathologic
  • can be direct or indirect hyperbilirubinemia
    • indirect causes
      • Crigler-Najar’s syndrome 
      • Gilbert’s synrome
      • breast milk jaundice
        • persistence of physiologic jaundice beyond first week of life
      • breast feeding failure jaundice
        • lactation failure leads to inadequate oral intake, hypovolemia, and hyperbilirubinemia
      • hemolytic anemia
        • e.g. spherocytosis, G6PD deficiency
    • direct causes
      • Dubin-Johnson syndrome
      • Rotor’s syndrome
      • infections
      • metabolic causes
        • e.g. galactosemia, alpha-1-antitrypsin deficiency
      • extrahepatic biliary atresia 
• destruction of bile ducts leads to hepatomegaly and cirrhosis

Evaluation

• Labs
• elevated direct and total bilirubin

Treatment

• Physiologic jaundice requires no treatment
• Phototherapy
• light photo-oxidizes unconjugated bilirubin, making it water-soluble and able to be excreted renally

Prognosis, Prevention, and Complications

• High bilirubin levels can lead to kernicterus
  • results from the irreversible deposition of billirubin in the basal ganglia, pons, and cerebellum
  • potentially fatal