Physiological jaundice

• What is physiological jaundice also known as?

  Neonatal (newborn) jaundice
• What is neonatal jaundice?


  Clinical condition

  Yellowing of newborn's skin & eyes

  Results from accumulation of bilirubin (byproduct of breakdown of RBCs) in body
• What are the causes of neonatal jaundice < 24 hrs after birth?


  Haemolytic disorders (Rhesus incompatibility, ABO incompatibility, G6PD deficiency, spherocytosis)

  Congenital infections

  Sepsis
• What are the causes of neonatal jaundice 24 hrs - 14 days after birth?


  Physiological jaundice

  Breast milk jaundice

  Dehydration

  Infection (inc sepsis)

  Haemolysis

  Bruising

  Polycythaemia

  Crigler-Najjar Syndrome
• What are the causes of neonatal jaundice > 14 days (> 21 days if preterm) after birth?


  Physiological jaundice

  Breast milk jaundice

  Infection

  Hypothyroidism

  Biliary obstruction (inc. biliary atresia)

  Neonatal hepatitis
• Why can physiological jaundice occur?


  Relative polycythaemia in newborns

  Shorter RBC lifespan compared to adults

  Less efficient hepatic bilirubin metabolism in first few days of life
• What is breast milk jaundice?


  Prolonged jaundice in newborns due to substances in breast milk.

  Seen in an otherwise well baby (and can suggest mild, but not clinical dehydration) and usually resolves within 6 weeks.
• What are the signs & symptoms of physiological jaundice?


  Yellowing of skin & eyes

  Poor feeding?

  Lethargy?
• What are the Inx for physiological jaundice?


  Obs

  Full Hx & examination

  Transcutaneous bilirubin levels (if elevated, confirm with serum bilirubin level)

  Consider bloods (depending on Hx & presentation)
• What is the management of physiological jaundice?


  Depends on bilirubin levels & whether child is symptomatic (asymptomatic = no treatment required)

  Phototherapy -> ensure there is also adequate fluid intake & eye care

  Exchange transfusion

  Monitor bilirubin levels

  
• What are the possible complications of neonatal jaundice?


  Complications are rare for breastmilk or physiological jaundice

  Related to phototherapy

  • loose stools
  • dehydration

  Kernicterus (bilirubin-induced brain dysfunction)