JAUNDICE

Question 1

History & Physical

Answer 1

Things to Ask:

Birth History

Feeding History

Stooling / Voiding
History

Weight Trend

Family History of jaundice / blood disorders, siblings that required phototherapy

Things to Look For:

Volume Status

Skin: blanching, jaundice in cephalocaudal pattern

Head: cephalohematoma, caput succedanum

Mouth: jaundice under tongue

Eyes: Scleral icterus

Abdo exam: hepatosplenomegally

Neuro Exam

Question 2

Pathologic hyperbilirubinemia

Answer 2

Rate of rise >5 mg / dL / day of total serum bilirubin

Hyperbilirubinemia before 24 hrs of life

Conjugate hyperbilirubinemia (>2 mg / dL OR >20% of total serum bilirubin)

Question 3

DDx: Unconjugated

Answer 3

Sepsis

TORCH

Drugs: Ceftriaxone

Benign Neonatal Hyperbilirubinemia: 24 hr - 5 days

Breastfeeding Jaundice: 1st week of life

Breastmilk Jaundice: after 1st week - 12 weeks

Hemolysis:
-Cephalohematoma
-Caput Succedeneum
-Neonatal polycythemia (maternal diabetes, fetal hypoxia, twin-twin transfusion, delayed cord clamping)
-Maternal-fetal ABO or Rh incompatability

Hypothyroid

Glucose-6-Phosphate dehydrogenase deficiency

Hereditary Spherocytosis

Gilbert

Crigler-Najar

Question 4

DDx: Conjugated

Answer 4

Biliary Atresia

Choledochal cyst

Alagille Syndrome

Question 5

Investigations

Answer 5

Transcutaneous Bilirubin Screen

Nonogram

CBC
Blood Type
Coomb’s Test Reticulocytes
LFT’s
PBS

Consider septic workup: U/A, U Clx, Blood Clx, LP, CXR

Abdominal U/S if Conjugated Hyperbilirubinemia

Question 6

Complications

Answer 6

bilirubin encephalopathy (kernicterus)