- Yellow colour (accumulation of un-conjugated bilirubin in skin), indicate Hyperbilirubinemia,
- Wide variability in correlation between visible jaundice and bilirubin level
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Clinical Definition:
Approach
Focused Hx
Physical Exams
Gold Standard Dx
SerumBilirubin (<20)
- Peak bilirubin level usually at 3-5 days of life
- Every baby should have a bilirubin level checked at 24-72 hours of life. Earlier check if appears jaundiced.
Etiology DDx → Key Investigations
*NOTE: this does not include Mimiker DDx. Open the disease sub-page to check for those
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🚩 !Red Flag (must not miss)
These are conditions that are emergently life-threatening or have severe consequences w/t early treatment
- Don’t default to physiological/breastfeeding (even though it is 95%)
| Key Red Flags |
Condition |
| Jaundice at less than 24 hours of age |
HDN |
| Direct (conjugated) Hyperbilirubinemia (conjugated >> unconjugated ) |
‣ |
| Congenital cancer |
|
| Rapid increase in bilirubin levels |
|
| ‣, ‣ /ill neonate |
TORCH Infection, GBS |
- Do U/S and other investigations immediately, consult peds
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Pre-hepatic (unconjugated)
- !Hemolysis → HDN
- Physiological
◦ All systems are starting to work, so not as effectively as they should
◦ Increase bilirubin load on the liver cell
◦ Decreased bilirubin conjugation
◦ Decreased bilirubin conjugation and ex retion
- Lactation (Breast Feeding) causes
- Dehydration (common)
- Cause: It’s hard to breastfeed
- Breast milk
- Sometimes something in the breast milk affect the glucuronidation
- Dx of exclusion: 2-3 day old and still jaundiced, but no other etiologies
- Lucey–Driscoll syndrome?
- Baby: switch to formula
- Mother: pump to maintain supply