Neonatal jaundice; causes, clinical assessment

Inadequacy of breastfeeding is a common cause of exaggerated neonatal jaundice during initial few days.

• Neonatal jaundice is the most common cause morbidity in the first week of life.
  • 60% of term newborns
  • 80% of preterm newborns
• Neonatal jaundice is the most common cause of re-admission after discharge from birth hospitalization.
  • In neonates is when total serum bilirubin (TSB) concentration exceeds 5 to 7 mg/dL.
    • visible in skin
    • eyes
  • In adults have jaundice visible in eyes when TSB concentration exceeds 2 mg/dL.
• Increased TSB concentration in neonate results from
  1. increased production
  2. decreased clearance and
  3. re-absorption

PHYSIOLOGICAL VERSUS PATHOLOGICAL JAUNDICE (neonatal jaundice)

• Jaundice attributable to physiological immaturity of neonates to handle increased bilirubin production is termed as physiological jaundice .
• ‘Pathological jaundice’ is said to be present when TSB concentrations are not in physiological jaundice .

What are the causes of pathological jaundice ( neonatal jaundice )

• Common causes of pathological jaundice in neonate include:
  • Hemolysis
  • Decreased conjugation
  • Increased enterohepatic circulation
  • Extravasated blood

Hemolysis

• Blood group incompatibility
• enzyme deficiencies
• autoimmune hemolytic anemia

Decreased conjugation

• Due to liver enzyme immaturity

Increased enterohepatic circulation

• Lack of adequate enteral feeding that includes insufficient breastfeeding or the infant not being fed because of illness, GI obstruction

Extravasated blood

• Cephalhematoma, extensive bruising increased the risk of neonatal jaundice.

CLINICAL ASSESSMENT OF NEONATAL JAUNDICE

The parents should be counselled.

Visual inspection of neonatal jaundice.

Inadequacy of breastfeeding is a common cause of exaggerated jaundice during initial few days (breastfeeding jaundice).

All neonates should be examined at every opportunity but not lesser than every 12 hr until first 3 to 5 days of life for jaundice.

At higher risk of jaundice should be identified.

Indications of TSB Measurement in neonatal jaundice

• Jaundice in first 24 hours.
• Beyond 24 hrs: If visually assessed, jaundice is likely to be more than 12 to 14 mg/dL (as visual assessment becomes unreliable) beyond this TSB level or approaching the phototherapy range or beyond.
• Unsure about visual assessment.
• During phototherapy.