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Physiological Neonatal Jaundice

Jaundice Physiologic of Newborn


Presentation

  • If jaundice is present, bilirubin levels should be measured If suspected physiological jaundice, use transcutaneous bilirubinometer (non-invasive) to do this in the first instance In early jaundice, infants (If transcutaneous measurement is 250μmol/l[dundeemedstudentnotes.wordpress.com]
  • Jaundice presenting in the first 24 hours of life Jaundice presenting in the first 24 hours of life is more likely to have a serious underlying cause such as infection, haemolytic disease or metabolic disorder.[patient.info]
  • In the present study the overall incidence of non physiological jaundice is 19% (107 out of 560).[medresearch.in]
  • By Age Early ( 24 hours) Early presentation is almost always pathological.[sharinginhealth.ca]
  • However, jaundice may be a presenting sign of life threatening disease. Examine the baby in a well lit room. Blanch the skin.[emed.ie]
Sepsis
  • • All other causes listed above 14 days Unconjugated Hypothyroidism Abnormal haemolysis Sepsis Breast milk jaundice – diagnosis of exclusion Conjugated as above [CP] – causes – old school classification: Pre-hepatic Hepatic Post hepatic [KB] – important[empem.org]
  • sepsis or inherited metabolic disorder.[emed.ie]
  • Neurologic examination should focus on signs of hypotonia or weakness (metabolic disorder, hypothyroidism, sepsis).[msdmanuals.com]
  • Also, in conditions like sepsis, asphyxia and acidosis, the blood-brain barrier is more susceptible to penetration.[learn.pediatrics.ubc.ca]
Anemia
  • Determination of the level of bilirubin in the blood is of value in detecting elevated bilirubin levels at the earliest stages before jaundice appears, when liver disease or hemolytic anemia is suspected. Jaundice in a horse's oral mucosa.[medical-dictionary.thefreedictionary.com]
  • Immune-mediated hemolytic anemias are relatively common in foals, calves and piglets, and may lead to jaundice. However, the most serious aspect of this disease is the anemia, rather than jaundice per se.[vivo.colostate.edu]
  • Risk Factors: Severe Hyperbilirubinemia (Infants 35 weeks gestation or further) Major risk factors Jaundice in first 24 hours (always pathologic) ABO or Rh incompatibility and positive Coombs test ( Hemolytic Anemia ) G6PD Deficiency Delivery at 35 to[fpnotebook.com]
  • Jaundice-preepatico -Hepatocellular Jaundice -Post-hepatic jaundice In the first case, preepatici for jaundice, the cause is before the liver, ie a much too bilirubin for hemolysis, sideroblastic anemia, thalassemia, sickle cell anemia (see anemia in[spazioinwind.libero.it]
  • Indications: Phototherapy failure: to prevent a rise in bilirubin to toxic levels Hydrops fetalis: to correct anemia and improve heart failure In hemolytic disease, immediately if- Cord bilirubin 5 mg/dl and Cord hemoglobin 10 g/dl 1 mg/dl/hr rise in[epomedicine.com]
Crying
  • A successful surgery, seeing the defib monitor showing signs of cardiac activity after a successful CPR, and the cry of a baby immediately after birth. If you have already, then you know what I'm talking about. But if you haven't, trust me.[firstclassmed.com]
  • […] or has a high-pitched cry Arches backward Has a stiff, limp or floppy body Has strange eye movements These may be warning signs of dangerously high levels of bilirubin that need quick treatment to prevent kernicterus.[marchofdimes.org]
  • Early phase: Hypotonia, Lethargy, High-pitched cry, Poor sucking b.[epomedicine.com]
  • Parenting support THE NEWBORN - The physiological infant, assessment at birth - Reflections of the newborn - The neonatal island - First care of the newborn - Hygiene of the newborn and dressing of the umbilical abutment - Common navel disorders - The cry[unipg.it]
  • TSB levels in the range indicated by the nomogram, with TSB levels of 25 mg/ dL or greater, and with jaundice and signs of acute bilirubin encephalopathy (lethargy, altered mental state, apnea, irritability, muscle tone abnormalities and/or altered cry[rn.com]
Physician
  • The presence of risk factors in an infant at discharge determines the timing and frequency of subsequent physician assessments. Sources Akobeng, Anthony K. "Neonatal Jaundice." American Family Physician 71 (2005): 947–8.[embryo.asu.edu]
  • Our doctors work side-by-side with physicians from Stanford Children’s Health to provide care in more than 25 pediatric specialty areas to help your child stay healthy.[cpmc.org]
  • Presentation Am Fam Physician . 2002 Feb 15; 65 ( 4 ):599-606. Clin Perinatol. 2013 Dec;40(4):679-88. CMAJ. 2015 Mar 17;187(5):335-43. Semin Fetal Neonatal Med . 2015 Feb;20 ( 1 ):6-13.[pathophys.org]
  • American Family Physician 65 (4) 599-606. Muchowski, K.E. (2014) Evaluation and treatment of neonatal hyperbilirubinemia. American Academy of Family Physicians 89 (11). 873-878. 2016. AMN Healthcare, Inc. All Rights Reserved.[rn.com]
  • As most healthy newborns require only a brief hospital stay, prompt follow up in the primary care physician’s office is recommended.[dukehealth.org]
Malnutrition
  • ., high GI obstruction ( pyloric stenosis, bowel obstruction ) Other causes: medication, hypothyroidism, malnutrition, polycythemia References: [1] [2] [3] Pathophysiology Pathological hyperbilirubinemia Subtypes and variants Clinical features Diagnostics[amboss.com]
  • Causes of Jaundice in Newborns Physiological Jaundice (50% of newborns) Onset 2 to 3 days of age Peaks day 4 to 5, then improves Disappears 1 to 2 weeks of age Breastfeeding or Malnutrition Jaundice ( 5 to 10% of newborns) Due to inadequate intake of[seattlechildrens.org]
  • […] dehydration as milk supply comes in) breast-milk jaundice (inhibitor of glucuronyl transferase) non-hemolytic infection/sepsis subdural hematoma, bruising (traumatic delivery, vacuum or forceps, malpresentation) mother with DM hypothyroidism hypoalbuminuria (malnutrition[sharinginhealth.ca]
Jaundice
  • For any Darwinian explanation of physiological neonatal jaundice to be considered in clinical circles, it is essential that the elevated incidence of PNJ in this population be explained both mechanistically and in terms of adaptation.[ncbi.nlm.nih.gov]
  • Published on Jul 10, 2016 Physiological Neonatal Jaundice and Its causes. Physiological Neonatal Jaundice 1. PHYSIOLOGICAL NEONATAL JAUNDICE 10/07/2016 1 2.[slideshare.net]
  • Our doctor suspects breast milk jaundice. He has prescribed Gardenal and Udiliv. What is the action of these 2 medicines? A: The fact that your son did not have jaundice at birth is a very good sign.[doctor.ndtv.com]
  • Jaundice is a pathological process. Why is it called “physiological jaundice” then? Basically, in the newborn baby's body, there are certain normal processes that can lead to this condition.[firstclassmed.com]
  • Abstract Jaundice is the most frequent condition identified in a newborn.[link.springer.com]
Jaundice
  • For any Darwinian explanation of physiological neonatal jaundice to be considered in clinical circles, it is essential that the elevated incidence of PNJ in this population be explained both mechanistically and in terms of adaptation.[ncbi.nlm.nih.gov]
  • Published on Jul 10, 2016 Physiological Neonatal Jaundice and Its causes. Physiological Neonatal Jaundice 1. PHYSIOLOGICAL NEONATAL JAUNDICE 10/07/2016 1 2.[slideshare.net]
  • Our doctor suspects breast milk jaundice. He has prescribed Gardenal and Udiliv. What is the action of these 2 medicines? A: The fact that your son did not have jaundice at birth is a very good sign.[doctor.ndtv.com]
  • Jaundice is a pathological process. Why is it called “physiological jaundice” then? Basically, in the newborn baby's body, there are certain normal processes that can lead to this condition.[firstclassmed.com]
  • Abstract Jaundice is the most frequent condition identified in a newborn.[link.springer.com]
Neonatal Jaundice
  • For any Darwinian explanation of physiological neonatal jaundice to be considered in clinical circles, it is essential that the elevated incidence of PNJ in this population be explained both mechanistically and in terms of adaptation.[ncbi.nlm.nih.gov]
  • Published on Jul 10, 2016 Physiological Neonatal Jaundice and Its causes. Physiological Neonatal Jaundice 1. PHYSIOLOGICAL NEONATAL JAUNDICE 10/07/2016 1 2.[slideshare.net]
  • Bertini G, Dani C, Tronchin M, Rubaltelli FF (2001) Is breastfeeding really favoring early neonatal jaundice? Pediatrics 107: E41 PubMed CrossRef Google Scholar 2.[link.springer.com]
  • Stevenson, Understanding neonatal jaundice: A perspective on causation. Pediatrics & Neonatology, 2010. 51(3): p. 1431 Lin, S., et al., Neonatal lupus erythematosus with cholestatic hepatitis.[pediatricsciences.com]
  • As correctly diagnosed, he suffered from physiologic neonatal jaundice which is now becoming increasingly common. A very large hospital in New Delhi is reporting up to 80% of the neonates as suffering from this temporary disorder.[doctor.ndtv.com]
Neonatal Jaundice
  • For any Darwinian explanation of physiological neonatal jaundice to be considered in clinical circles, it is essential that the elevated incidence of PNJ in this population be explained both mechanistically and in terms of adaptation.[ncbi.nlm.nih.gov]
  • Published on Jul 10, 2016 Physiological Neonatal Jaundice and Its causes. Physiological Neonatal Jaundice 1. PHYSIOLOGICAL NEONATAL JAUNDICE 10/07/2016 1 2.[slideshare.net]
  • Bertini G, Dani C, Tronchin M, Rubaltelli FF (2001) Is breastfeeding really favoring early neonatal jaundice? Pediatrics 107: E41 PubMed CrossRef Google Scholar 2.[link.springer.com]
  • Stevenson, Understanding neonatal jaundice: A perspective on causation. Pediatrics & Neonatology, 2010. 51(3): p. 1431 Lin, S., et al., Neonatal lupus erythematosus with cholestatic hepatitis.[pediatricsciences.com]
  • As correctly diagnosed, he suffered from physiologic neonatal jaundice which is now becoming increasingly common. A very large hospital in New Delhi is reporting up to 80% of the neonates as suffering from this temporary disorder.[doctor.ndtv.com]
Scleral Icterus
  • The most notable signs of hyperbilirubinemia are jaundice and scleral icterus. Jaundice refers to yellowing of the skin, which can be seen by blanching the skin with digital pressure.[pathophys.org]
Osteoporosis
  • Osteoporosis, Riesgo de Rischio di ostruzione delle vie aeree Obstrucción de la vía aérea, Riesgo de Rischio di ostruzione intestinale Oclusión intestinal, Riesgo de Rischio di otite Otitis, Riesgo de Rischio di pancreatite Pancreatitis, Riesgo de Rischio[atic.com.es]
Suggestibility
  • This treatise examines this hypothesis in light of novel epidemiological and genetic findings which suggest that the incidence of PNJ is significantly increased in East Asian populations.[ncbi.nlm.nih.gov]
  • In view of the concern and anxiety which any problem with an infant causes to parents, I always routinely suggest a second opinion from another paediatrician.[doctor.ndtv.com]
  • It has been suggested that bilirubin uptake in the gut (enterohepatic circulation) is increased in breast fed babies, possibly as the result of increased levels of epidermal growth factor (EGF) in breast milk.Breast milk also contains glucoronidase which[slideshare.net]
  • […] group, viral serology) Family history of haemolytic disease (ABO/G6PD, spherocytosis) Dark urine or pale stools (suggest biliary obstruction) Level of icterus in terms of cephalocaudal progression (but often unreliable) Plethora (may suggest polycythaemia[rch.org.au]
  • Suggest review in General Paediatrics clinic if not improving or any changes - especially stool colour. Conjugated hyperbilirubinaemia must be excluded as the causes of this pattern need urgent evaluation and treatment.[emed.ie]
Lethargy
  • […] empiric antibiotic therapy G6PD deficiency Usually rapidly progressive jaundice in an otherwise well baby Low haemoglobin and high indirect bilirubin More common in families of Mediterranean origin Galactosaemia Vomiting, convulsions, irritability and lethargy[dundeemedstudentnotes.wordpress.com]
  • Important associated symptoms include lethargy and poor feeding (suggesting possible kernicterus), which may progress to stupor, hypotonia, or seizures and eventually to hypertonia.[msdmanuals.com]
  • Kernicterus can cause: first few days: lethargy, poor feeding, vomiting, high pitched cry, seizures, decreased tone first week: opisthotonos, fever, increased tone, bulging fontanelles, pulmonary hemorrhage chronic: hearing damage, strabismus, mental[sharinginhealth.ca]
  • Early phase: Hypotonia, Lethargy, High-pitched cry, Poor sucking b.[epomedicine.com]
  • […] guidelines for exchange transfusion were published by the AAP, and should be performed on infants with TSB levels in the range indicated by the nomogram, with TSB levels of 25 mg/ dL or greater, and with jaundice and signs of acute bilirubin encephalopathy (lethargy[rn.com]
Seizure
  • Kernicterus, in both acute and chronic forms, is manifest by a variety of neurologic and cognitive deficits ranging from poor suckling and seizures to low IQ. Clearly, this disorder should be treated without delay.[vivo.colostate.edu]
  • This disease leads to mental retardation, deafness and seizures. Aggravation of jaundice can cause muscle infection, which leads to complete paralysis.[mother-top.com]
  • Advance phase: Pronounced opisthotonus, shrill cry, apnea, seizures, coma and death 2.[epomedicine.com]
  • The signs of acute bilirubin encephalopathy include: lethargy poor feeding temperature instability hypotonia arching of the head, neck and back (opisthotonos) spasticity seizures. Death may follow.[www2.health.vic.gov.au]
  • Symptoms of kernicterus can be severe and include: lethargy, irritability, hypotonia, opisthotonos, seizures, mental retardation, and hearing loss.[learn.pediatrics.ubc.ca]
Irritability
  • Babies can be very irritable, fussy, may have fever or they can have no symptoms. In addition to blood work to look for infections, other testing may be performed.[patients.gi.org]
  • […] cultures and start empiric antibiotic therapy G6PD deficiency Usually rapidly progressive jaundice in an otherwise well baby Low haemoglobin and high indirect bilirubin More common in families of Mediterranean origin Galactosaemia Vomiting, convulsions, irritability[dundeemedstudentnotes.wordpress.com]
  • The neonate may be sleepy but hypotonic or have a high-pitched cry; he maybe irritable or inconsolable, jittery or lethergic. The dehydration and neurologic dysfunction from hyperbilirubinemia may even cause fever.[pemplaybook.org]
  • […] published by the AAP, and should be performed on infants with TSB levels in the range indicated by the nomogram, with TSB levels of 25 mg/ dL or greater, and with jaundice and signs of acute bilirubin encephalopathy (lethargy, altered mental state, apnea, irritability[rn.com]
Convulsions
  • […] and blood cultures and start empiric antibiotic therapy G6PD deficiency Usually rapidly progressive jaundice in an otherwise well baby Low haemoglobin and high indirect bilirubin More common in families of Mediterranean origin Galactosaemia Vomiting, convulsions[dundeemedstudentnotes.wordpress.com]
  • This disease can present with jaundice in the newborn period and is associated with other severe symptoms (such as lethargy, vomiting, irritability and possibly convulsions).[patients.gi.org]

Workup

  • 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]
Bilirubin Increased
  • If Mother Rh -, Child Rh Cord Blood Hb Corl Blood Bilirubin 5 mg % Direct Coomb's ve This is an Indication for Exchange transfusion. 3. if Bilirubin increase rate 0.5 mg/dl/hr 4. If Jaundice persists 7days in term 14days in preterm 5.[mediconotebook.com]
  • This is a very rare disease; the level of bilirubin increases very rapidly within hours. Immediate attention by a newborn specialist is then needed.[patients.gi.org]
  • Bilirubin-induced complications can be prevented by introducing a neonatal jaundice protocol to identify infants at risk for significant bilirubin increases, by ensuring adequate parental education and providing for follow-up care.[healthofchildren.com]
  • Shorter neonatal RBC life span increases bilirubin production; deficient conjugation due to the deficiency of UGT decreases clearance; and low bacterial levels in the intestine combined with increased hydrolysis of conjugated bilirubin increase enterohepatic[msdmanuals.com]
Albumin Increased
Bilirubin Level Increased
  • Other criteria of non-physiologic jaundice are visible jaundice on the first day of life, a total serum bilirubin level increasing by more than 5 mg/dl per day, a direct serum bilirubin level exceeding 1.5 mg/dl, and clinical jaundice persisting for more[uichildrens.org]

Treatment

  • Disappears without treatment. Need treatment according to the cause. 6.[slideshare.net]
  • ., Treatment of neonatal hyperbilirubinemia. Jornal de Pediatria, 2001. 77(Supl 1): p. S Javed, S., K. Kohli, and M. Ali, Patented Bioavailability Enhancement Techniques of Silymarin.[pediatricsciences.com]
  • What Are the Treatments for Newborn Jaundice? Often, physiologic jaundice -- the type seen in most newborns -- does not require aggressive treatment.[webmd.com]
  • Treatment for jaundice in babies Treatment for jaundice in babies depends on the cause, but may include: Mild jaundice – if the baby is otherwise healthy and well, no treatment is necessary.[betterhealth.vic.gov.au]
  • Treatment for jaundice starts at levels that are far lower that those that could cause kernicterus. Light therapy (phototherapy) is the most common treatment for jaundice.[dukehealth.org]

Prognosis

  • Free unconjugated bilirubin can cross the blood brain barrier of the baby and cause neuronal damage which is called “kernicterus” ; the prognosis for such babies isn't very good, so we need to identify jaundice earlier and start treatment if necessary[firstclassmed.com]
  • IV immunoglobulin References: [3] [5] [8] Prognosis Prevention[amboss.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]
  • Prognosis The prognosis for physiological neonatal jaundice is generally very good.[healthofchildren.com]
  • Newborn Jaundice Prognosis The majority of children with jaundice will recover fully and without permanent adverse effects.[emedicinehealth.com]

Etiology

  • The etiology of the jaundice is quite varied; although most causes are benign, each case must be investigated to rule out an etiology with significant morbidity.[uichildrens.org]
  • […] of conjugated hyperbilirubinemia Etiology of unconjugated hyperbilirubinemia Decreased bilirubin excretion Intrahepatic cholestasis Sepsis Hepatitis A Hepatitis B TORCH infections Cystic fibrosis Extrahepatic cholestasis Biliary atresia Choledochal cyst[amboss.com]
  • Etiological verification is essential because the underlying diseases are critical factors of neurological sequelae [ 7 ]. There is a wide range of conditions that affect bilirubin levels, including environmental and genetic origins.[omicsonline.org]
  • (Phototherapy) Treatment depends on the severity of hyperbilirubinemia, its etiology, and the risk of developing serious neurological complications. Phototherapy The mainstay of treatment for hyperbilirubinemia is phototherapy .[pathophys.org]
  • PATHOLOGIC JAUNDICE All etiologies of jaundice beyond physiologic and breastfeeding or breast milk jaundice are considered pathologic.[aafp.org]

Epidemiology

  • This treatise examines this hypothesis in light of novel epidemiological and genetic findings which suggest that the incidence of PNJ is significantly increased in East Asian populations.[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]
  • Background/Epidemiology Common (up to 60% term infants and 80% preterm infants) Usually physiological- not pathological (important, however, to recognise the difference) Can potentially be toxic (mainly to the brain- kernicterus) occurs mainly when unconjugated[dundeemedstudentnotes.wordpress.com]
  • Epidemiology Incidence About 60% of all babies have jaundice. Some babies are more likely to have severe jaundice and higher bilirubin levels than others.[ourmed.org]
  • Epidemiology Approximately 60% of term and 80% of preterm babies develop jaundice in the first week of life; about 10% of breast-fed babies are still jaundiced at 1 month of age [ 3 ] .[patient.info]
Sex distribution
Age distribution

Pathophysiology

  • ., high GI obstruction ( pyloric stenosis, bowel obstruction ) Other causes: medication, hypothyroidism, malnutrition, polycythemia References: [1] [2] [3] Pathophysiology Pathological hyperbilirubinemia Subtypes and variants Clinical features Diagnostics[amboss.com]
  • . • The student must have acquired the necessary knowledge for the autonomous assistance to the physiological birth as well as the knowledge related to the pathophysiology and assistance of the puerperium.[unipg.it]
  • The acquired form is more common, and pathophysiology has not been fully elucidated.[pathophys.org]
  • […] is seen with: East Asian, Mediterranean native American heritage prematurity traumatic delivery infection hemolysis acidosis hypoalbuminemia non-optimal feeding/dehydration (formula or inadequate breast milk) drugs polycythemia metabolic deficiency Pathophysiology[sharinginhealth.ca]

Prevention

  • ., Efficacy of phototherapy in prevention and management of neonatal hyperbilirubinemia. Pediatrics, 1985. 75(2): p. 393. De Carvalho, M., Treatment of neonatal hyperbilirubinemia. Jornal de Pediatria, 2001. 77(Supl 1): p. S Javed, S., K.[pediatricsciences.com]
  • It must deepen, for the part of competence, the methods of prevention and rehabilitation of perineal damage and techniques related to the first treatment of the newborn.[unipg.it]
  • Can Jaundice in the breastfed baby be prevented? Jaundice occurs in 50-70% of all newborns, so there is really no way to prevent it from occurring.[americanpregnancy.org]
  • Prevention The majority of cases cannot be prevented as they fall into the physiological group.[health24.com]
  • These can prevent the excretion of bilirubin through the intestines. It starts after the first 3 to 5 days and slowly improves over 3 to 12 weeks.[kidshealth.org]

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