![]() ![]() Feeding stimulates the gastrocolonic reflex and increases intestinal motility, clearance of meconium and conjugated bilirubin from the gut. ![]() The impact of feeding frequency can be a contributing cause of jaundice in the breastfed baby. The use of early versus late onset is preferred by many over using the terms physiological or pathological jaundice. It is important not to imply that breast milk jaundice is harmful, thereby influencing a mother’s choice not to breastfeed. There is controversy in the literature as to how to classify breast milk jaundice. Causes of physiological and pathological jaundice can be linked to each stages of metabolism ( Table 64.2). Pathological jaundice can present on day 1 or it can be prolonged, persistent after day 14 in the term infant or day 21 in the preterm infant. Pathological jaundice, on the other hand, should raise concern and always requires further investigation. Serum bilirubin (SBR) levels will peak by day 4 and reduces by day 14. ![]() Jaundice is classified as physiological or pathological. Physiological versus pathological jaundice Alterations at any of these stages can result in jaundice ( Table 64.1). There are four stages involved in bilirubin metabolism. In order to provide informed care for a jaundiced baby and parents it is important to have an understanding of bilirubin metabolism. Jaundice in the newborn is common, occurring in over two-thirds of term infants and even more frequently in the preterm infant. Infection: sepsis, urinary tract infection, syphilis, toxoplasmosis, tuberculosis, hepatitis, rubella, herpes Metabolic disorder: alpha 1 antitrypsin deficiency, cystic fibrosis, galactosemia, glycogen storage disease, Gaucher's disease, hypothyroidism, Wilson's disease, Niemann-Pick diseaseĬhromosomal abnormality: Turner's syndrome, trisomy 18 and 21 syndromes Drugs: aspirin, acetaminophen, sulfa, alcohol, rifampin (Rifadin), erythromycin, corticosteroids, tetracyclineĬharacteristics: increased unconjugated bilirubin level, >6 percent reticulocytes, hemoglobin concentration of <13 g per dL (130 g per L)Ĭoombs' test positive: Rh factor incompatibility, ABO incompatibility, minor antigensĬoombs' test negative: red blood cell membrane defects (spherocytosis, elliptocytosis), red blood cell enzyme defects (G6PD deficiency, pyruvate kinase deficiency), drugs (e.g.Jaundice occurs when bilirubin accumulates in the extravascular fatty tissues (skin and brain). The management goals are to exclude pathologic causes of hyperbilirubinemia and initiate treatment to prevent bilirubin neurotoxicity.Ĭharacteristics: increased unconjugated bilirubin level, normal percentage of reticulocytesĬharacteristics: increased unconjugated and conjugated bilirubin level, negative Coombs' test, conjugated bilirubin level of >2 mg per dL (34 μmol per L) or >20% of total serum bilirubin level, conjugated bilirubin in urineīiliary obstruction: biliary atresia, choledochal cyst, primary sclerosing cholangitis, gallstones, neoplasm, Dubin-Johnson syndrome, Rotor's syndrome Jaundice is considered pathologic if it presents within the first 24 hours after birth, the total serum bilirubin level rises by more than 5 mg per dL (86 mol per L) per day or is higher than 17 mg per dL (290 mol per L), or an infant has signs and symptoms suggestive of serious illness. Few term newborns with hyperbilirubinemia have serious underlying pathology. Phototherapy should be instituted when the total serum bilirubin level is at or above 15 mg per dL (257 mol per L) in infants 25 to 48 hours old, 18 mg per dL (308 mol per L) in infants 49 to 72 hours old, and 20 mg per dL (342 mol per L) in infants older than 72 hours. More recent recommendations support the use of less intensive therapy in healthy term newborns with jaundice. Historically, management guidelines were derived from studies on bilirubin toxicity in infants with hemolytic disease. Hyperbilirubinemia is one of the most common problems encountered in term newborns. ![]()
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