![]() ![]() Other possible causes of indirect hyperbilirubinemia include dehydration, hemolysis, infection, congenital hypothyroidism, inborn diseases of metabolism, and pyloric stenosis. However, the diagnosis of breast milk jaundice is made by excluding other causes. Besides, breastmilk jaundice may extend up to the twelfth week of life. It is known that breastmilk jaundice is seen at a rate of 1.3% in newborn infants and 2.4–25% in infants fed with breastmilk. To date, the most common cause of prolonged jaundice of indirect hyperbilirubinemia has been identified as breastmilk jaundice. Distinguishing between these types of jaundice is crucial in determining the etiology of prolonged jaundice. Īlthough jaundice in early infancy is predominantly caused by indirect hyperbilirubinemia, it can also be seen as direct hyperbilirubinemia. Neonatal jaundice still maintains its importance in neonatal clinical practice, since early diagnosis and treatment is feasible. The timing of initial investigations should be between two and four weeks in order to reduce the associated mortality and morbidity. For this reason, health care providers should not take unnecessary tests in normal infants, but should also recognize infants with a causative pathology. The most important point is to determine whether prolonged jaundice is of a benign cause or is due to a substantial disease. ![]() Īlthough underlying cause can not be found in the majority of prolonged jaundice cases, this may also be the first sign of a serious causative pathology. It affects 2–15% of all newborns and 40% of breastfed infants. 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.Prolonged jaundice is defined as a serum bilirubin level higher than 85 μmol/L (5 mg/dl), which persists at postnatal 14 days in term infants and 21 days following the birth in preterm infants. 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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