Neonatal Jaundice

Question 1

What are the lab values and presentation that is consistent with physiologic jaundice?

Answer 1

onset after 1st day, peaking at 3-5d
excess bilirubin is unconjuated, peaks at 12-15mg/dL
clinical resolution by 1wk

Question 2

What are the lab values and presentation that is consistent with breast-milk jaundice?

Answer 2

peaks at 10-15d thought to be due to some unknown inhibitor (UGT inhibit?) in breast milk, corrects with trial of formula

Question 3

What are two causes of extreme unconjugated hyperbilirubenmia of infancy.

Answer 3

defects of glucuronidation: Gilberts, Crigler-Najjar
hemolysis

consider treatment with phototherapy, exchange transfusion for bilirubin >20-25 (and even lower levels in premature infants) due to danger of kernicterus

Question 4

What are two causes of extreme conjugated hyperbilirubenmia of infancy.

Answer 4

defects in handling or export of conjugated bilirubin: Rotor or Dubin Johnson (no signs liver injury)
hepatocyte injury (increased ALT, AST)
biliary obstruction (increased GGT)

Question 5

What conditions could dispose an infant to severe unconjugated hyperbilirubinemia?

Answer 5

ABO incompatibility
G6PD deficiency
prematurity
chephalhematoma/bruising
exclusive breastfeeding
east asian background

Question 6

Is jaundice with onset <24h of age pathological?

Answer 6

yes, requires urgent evaluation, consider hemolytic disease

Question 7

What is the evaluation required of a newborn with prolonged jaundice?

Answer 7

fractionated bilirubin levels
liver enzyme levels
+ additional tests for surgical exploration

Question 8

What are possible causes of (prolonged) conjugated hyperbilirubinemia in the neonate?

Answer 8

extra hepatic biliary atresia (30-35%)
idiopathic neonatal hepatitis (30-35%)
metabolic/genetic (15%)
intrahepatic cholestasis, abnormal bile ducts (5%)
non-bacterial infection (5%) CMV, rubella, HSV, toxoplasma

Question 9

What is the classic EHBA classic presentation?

Answer 9

healthy term infant with prolonged jaundice
echoic stools, weight gains slows
high conjugated bile
increased ALP, GGT> AST, ALT
can be accompanied portal HTN

should be evaluated (absence of gallbladder is a hint) with ultrasound and biopsy (bile plugs and duct proliferation)

fatal by 8-12 mo without surgery (Kasai procedure, best outcome by 7-8wks)