![]() ![]() The jaundiced newborn is easily recognised if physicians and nurses are observant. ![]() ![]() Jaundice can be appreciated once the SBR is greater than 75-80 micromol/L. The possibility of an acute haemolytic process must always be considered, especially if there is visible jaundice within the first 24 hours of life. The evaluation of the jaundiced newborn must include a thorough history and physical examination, measurement of the transcutaneous and/or serum bilirubin (SBR), and other investigations as indicated. structural abnormalities of the liver and hepatobiliary tract.increased enterohepatic circulation of bilirubinĬonditions that cause prolonged jaundice, late onset jaundice, or conjugated hyperbilirubinaemia include:.abnormality of hepatic membrane receptors and/or hepatic enzymes.increased degradation of red blood cells as a direct consequence of either enzymatic or structural defects of the red blood cell.Conditions that cause early onset neonatal jaundice include: Jaundice occurring within the first 24 hours of life must be considered to be pathological until proven otherwise. Physiological and pathological jaundice overlap and furthermore, both may be occurring simultaneously. Atypical jaundice - early onset jaundice, a rapidly rising bilirubin, prolonged jaundice, late onset jaundice or conjugated hyperbilirubinaemia - is likely to reflect pathology. The serum bilirubin was measured before discharge, and the zone in which the value fell predicted the likelihood of a subsequent bilirubin value exceeding the 95th percentile.Īlthough most jaundice is mild and physiological in origin, it cannot be safely assumed to be either. failure to recognise important risk factors including gestational age 36 weeks and birthweight > 2,000 g, or GA > 35 and birthweight > 2,500 g) based on the hour-specific serum bilirubin values.The key root causes that appear to be significant contributors to the reported cases of kernicterus include: Īcute bilirubin encephalopathy and kernicterus, although less common than previously, are still occurring. Numerous guidelines for the management of jaundiced neonates have been published but their effectiveness has not been validated by properly designed clinical trials. The data from numerous studies of bilirubin toxicity are so complex that it has been difficult to derive a rational approach for the management of the jaundiced neonate. The clinical challengeĭespite improvements in neonatal care and the virtual absence of classic kernicterus, safe serum bilirubin levels have not been established with absolute certainty. The full spectrum of adverse outcomes for hyperbilirubinaemia and the safety of many interventions are not known. The evidence for managing jaundice is poor especially in unhealthy newborns and preterm infants. It is important to appreciate that a jaundiced newborn’s symptoms may be attributed to the jaundice when in fact they are due to other pathology. Jaundice may be a sign of pathology, and demands appropriate evaluation and rational management. ![]() It is a transient physiological phenomenon for most newborns that may be regarded as a manifestation of their ongoing adaptation to the extrauterine environment. The jaundice, which is almost universal, has been called physiological jaundice. Approximately 60% of term newborn infants and 80% of preterm infants will have visible jaundice during the first week of life. Neonatal jaundice, which usually presents as an unconjugated hyperbilirubinaemia, is one of the most common physical signs observed amongst newborn infants. of New Haven, Connecticut and Cary, North Carolina. Andrew James BSc, MBChB, MBI, FRACP, FRCP The material presented here was first published in the Residents’ Handbook of Neonatology, 3rd edition, and is reproduced here with permission from PMPH USA, Ltd. ![]()
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