Presentation
Her presentation was ultimately explained with a diagnosis of both conditions, and required treatment with phenobarbitone. [ncbi.nlm.nih.gov]
Gastrointestinal
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Intestinal Atresia
atresia or stenosis, pyloric stenosis, biliary atresia ) TORCH toxoplasmosis, other pathogens, rubella, cytomegalovirus, and herpes simplex. [merckmanuals.com]
atresia Bilirubin undersecretion: Conjugation defect or delay: Criggler-Najar syndrome, Gilbert syndrome, Hypothyroidism, Prematurity, UDGP-T variant Increased enterohepatic circulation: Inadequate breastfeeding (Breast feeding jaundice), Intestinal [epomedicine.com]
Liver, Gall & Pancreas
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Jaundice
The prevalence of neonatal jaundice was 55.2%; however, only 10% of black babies who were diagnosed with jaundice appeared clinically jaundiced. Normal vaginal delivery was the only risk factor associated with neonatal jaundice. [ncbi.nlm.nih.gov]
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Neonatal Jaundice
Black race and maternal smoking were not protective against neonatal jaundice as in some other studies. CONCLUSION: More than half (55.2%) of healthy term neonates developed neonatal jaundice. [ncbi.nlm.nih.gov]
Skin
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Yellow Discoloration of the Skin
Engelsk definition Yellow discoloration of the SKIN; MUCOUS MEMBRANE; and SCLERA in the NEWBORN. It is a sign of NEONATAL HYPERBILIRUBINEMIA. [mesh.kib.ki.se]
Definition Neonatal jaundice is the yellowing discoloration of the skin and sclera of a neonate, which is caused by increased levels of bilirubin in the blood. A neonate refers to an infant in the first 28 days of life. [bestpractice.bmj.com]
The yellow discoloration of the skin will begin on the face and forehead and extend toward the feet as the levels of bilirubin increase. [medicinenet.com]
In neonates, the yellow discoloration of the skin is first noted in the face and as the bilirubin level rises proceeds caudal to the trunk and then to the extremities. [dbpedia.org]
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Sweating
[…] bilirubin alone is elevated Coombs' test used to distinguish between immune mediated hemolytic disorders (ABO incompatability) and non-immune-mediated hemolytic disorders including G6PD deficiency hereditary spherocytosis LFTs, alk phos, bile acids, and sweat [step2.medbullets.com]
Ears
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Hearing Impairment
Although 71.7% and 69.7%, respectively, of the mothers knew that severe jaundice could cause death and brain damage, only 38.4% of them were aware that severe jaundice could result in hearing impairment. [ncbi.nlm.nih.gov]
When monitored and treated in a timely manner, progression of severe hyperbilirubinemia can be curtailed and prevent kernicterus, a life long athetoid cerebral palsy and/or sensori-neural hearing impairment. [nature.com]
Olusanya BO, Neumann KJ, Saunders JE: The global burden of disabling hearing impairment: a call to action. Bull World Health Organ 2014;92:367-373. Thaddeus S, Maine D: Too far to walk: maternal mortality in context. Soc Sci Med 1994;38:1091-1110. [karger.com]
Neurologic
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Cognitive Impairment
There is also controversial discussion about the relationship between NH and developmental delay, cognitive impairment or behavioural disorders [ 29 ]. These will only become evident when the child is older than one year of age. [bmcpediatr.biomedcentral.com]
Workup
Do workup for underlying cause if receiving phototherapy, appears ill, or bili rising rapidly (i.e. crossing percentiles), and no obvious explanation on Hx/Px: Total and (with the first measurement) direct bilirubin--If the latter is elevated, check u [faculty.washington.edu]
An additional workup for hyperbilirubinemia may include: Blood group and direct Coombs testing in babies who are at risk of Rh or ABO isoimmunization. [pathophys.org]
In up to 50 percent of infants with severe jaundice, breastfeeding and lower gestational age were the only causes identified despite extensive workups. [healthofchildren.com]
Serum
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Erythrocytes Decreased
Etiology Physiologic jaundice is caused by a combination of increased bilirubin production secondary to accelerated destruction of erythrocytes, decreased excretory capacity secondary to low levels of ligandin in hepatocytes, and low activity of the bilirubin-conjugating [emedicine.com]
Prognosis
Prognosis depends on timely diagnosis and management. We evaluated the clinical practices among healthcare professionals concerning jaundiced newborns and their ability to recognize pale stools. [ncbi.nlm.nih.gov]
Prevention, and Complications Prognosis ranges widely can spontaneously resolve or be fatal depending on etiology Prevention preventive measures are usually not available stop breast-feeding to speed resolution of neonatal jaundice, though not required [step2.medbullets.com]
Prognosis This is dependent on the underlying cause but otherwise excellent with prompt diagnosis and treatment. Biliary atresia requires surgery within the first two months of life for a better prognosis [ 5 ] . [patient.info]
Etiology
Many different etiologies come into play together, and at times, it is difficult to isolate the cause of neonatal jaundice. [ncbi.nlm.nih.gov]
Figure 1: Etiologies of neonatal jaundice. [omicsonline.org]
Epidemiology
Abstract Using guidelines of the Meta-analysis of Observational Studies in Epidemiology Group, we systematically reviewed the literature on neonatal jaundice (unconjugated hyperbilirubinemia) and Autism Spectrum Disorder (ASD) in term and preterm infants [ncbi.nlm.nih.gov]
Epidemiology: Up to 60% of term and 80% or prem neonates become clinically jaundiced during the first week of life. Most resolve within 2 weeks and remain well throughout and require no treatment or intervention. [empem.org]
The epidemiology of neonatal hyperbilirubinemia. Stevenson DK, Maisels MJ, Watchko JF. Care of the jaundiced neonate. New York: McGraw-Hill; 2012. 97-113. Maisels MJ, Gifford K. [emedicine.com]
Pathophysiology
Abstract Fetal distress represents a pathophysiological condition in which oxygen is not available to the fetus in sufficient quantities. [ncbi.nlm.nih.gov]
NEONATAL HYPERBILIRUBINEMIA Pathophysiology Causes of Neonatal Hyperpbilirubinemia Evaluation of Neonatal Jaundice When to Treat How to Treat PATHOPHYSIOLOGY "Bilirubin encephalopathy" Refers to a neonatal syndrome of neurologic abnormalities and, in [faculty.washington.edu]
The acquired form is more common, and pathophysiology has not been fully elucidated. [pathophys.org]
Prevention
Recognition and treatment of Rh hemolytic disease, another known preventable cause of kernicterus, is critical. In addition, effective phototherapy is crucial if we are to make kernicterus a "never-event." [ncbi.nlm.nih.gov]
Timely detection, monitoring, and treatment within this window is effective in preventing most bilirubin-induced mortality. [doi.org]
Figure 1 Medical and preventive strategies to reduce hyperbilirubinemia. Figure 2 Approaches to achieve aviation safety standards to prevent extreme hyperbilirubinemia. [nature.com]