Neonatal Jaundice

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Hyperbilirubinaemia may be due to unconjugated or conjugated bilirubin, or a mixture.

  • Physiological jaundice due to an immature liver peaks at days 2-3 usually
  • Early jaundice within 24 hours is usually pathological.
  • Prolonged jaundice is defined as hyperbilirubinaemia beyond age 14 days and must be investigated to exclude pathological causes.


Contents

Causes of Prolonged Neonatal Jaundice

Unconjugated hyperbilirubinaemia

  • Physiological
  • Breast milk
  • Cephalohaematoma
  • Infection eg. UTI
  • Galactosaemia (early)
  • Hypothyroidism / Hypopituitarism
  • Polycythaemia
  • Haemolytic
    • Haemolytic disease of the newborn (Rh, ABO, Kell)
    • Membrane defects: Spherocytosis, Elliptocytosis
    • Enzyme defects: G6PDD, Pyruvate kinase deficiency
    • Sepsis
  • Enzyme dysfunction
    • Gilbert's syndrome
    • Crigler Najjar syndrome


Conjugated hyperbilirubinaemia

Hepatic

  • Infections
    • UTI
    • TORCH
    • Hepatitis viruses
  • Neonatal Hepatitis
  • Hypothyroidism / Hypopituitarism
  • Galactosaemia (later)
  • Cystic fibrosis
  • Alpha-1 antitrypsin deficiency
  • Parenteral nutrition
  • Amino / organic acidurias

Post-hepatic

Clinic Investigation: Neonatal Prolonged Jaundice Screen

Hospitals will have their own local policies regarding when and with which tests to investigate prolonged jaundice.

  • Some hospitals will investigate babies who are jaundiced at 14 days, whilst otherw wait until day 21.
  • The purpose of investigation is to exlude pathological causes and to allow diagnosis and action where necessary.


Document:

  • Mother's blood group
  • Contact phone number
  • DOB / Age of baby
  • Birth and current weight
  • Mode of delivery
  • Method of feeding
  • Stool and urine colour
  • Any additional history
  • Relevant family history
    • Haemoglobinopathies
    • ABO incompatibility
    • Spherocytosis, etc.
  • Physical examination


Laboratory Investigations

  • Blood
    • Bilirubin (total and conjugated)
    • Liver function tests
    • Thyroid function tests
    • Blood group and Direct Coombs Test (Direct antiglobulin test)
    • Full blood count
  • Urine
    • Microscopy and culture
    • Reducing substances test (must go to laboratory within 1 hour).


Ensure all results are reviewed and repeated / acted on / communicated as necessary.

  • Inform GP and Parents


Yellow Alert Campaign

Awareness campaigns both within the medical profession and public domain have produced significant improvements in outcome.
CLDF Yellow Alert


The Children's Liver Foundation launched the 'Yellow Alert' Campaign to promote awareness. A useful protocol for investigating neonatal jaundice can be found on their website (References).


References

Emedicine article

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