Neonatal Jaundice Flashcards
What are the lab values and presentation that is consistent with physiologic jaundice?
onset after 1st day, peaking at 3-5d
excess bilirubin is unconjuated, peaks at 12-15mg/dL
clinical resolution by 1wk
What are the lab values and presentation that is consistent with breast-milk jaundice?
peaks at 10-15d thought to be due to some unknown inhibitor (UGT inhibit?) in breast milk, corrects with trial of formula
What are two causes of extreme unconjugated hyperbilirubenmia of infancy.
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
What are two causes of extreme conjugated hyperbilirubenmia of infancy.
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)
What conditions could dispose an infant to severe unconjugated hyperbilirubinemia?
ABO incompatibility G6PD deficiency prematurity chephalhematoma/bruising exclusive breastfeeding east asian background
Is jaundice with onset <24h of age pathological?
yes, requires urgent evaluation, consider hemolytic disease
What is the evaluation required of a newborn with prolonged jaundice?
fractionated bilirubin levels
liver enzyme levels
+ additional tests for surgical exploration
What are possible causes of (prolonged) conjugated hyperbilirubinemia in the neonate?
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
What is the classic EHBA classic presentation?
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)