A condition of yellowish skin color during the newborn period due to the elevation of serum bilirubin

more than 1.5 mg(normal at birth)

Metabolism of bilirubin:

Break down of RBC’s releases Hb which in turn disintegrates into a part called Haem containing the iron part, and Globulin the protien partm. Then Haem gets converted into bilirubin which is called unconjugated or indirect bilirubin which circulates in the blood loosely connected to the globulin. When the blood reaches the liver the bilirubin gets metabolised by series of enzymes and gets coverted to conjugated or direct bilirubin, which gets excreted via the bile duct and thrown into gut which is excreted with the stool in the form of stercobilin which colors the stool brown, or stored in the gall bladder

Types:

Pathogenic :

Non-physiologic, prolonged, or pathogenic jaundice in the newborn may have many causes. Risk factors for a greater degree of jaundice include prematurity and different races. Other conditions may cause pathologic (disease-related) jaundice in the newborn and should be ruled out if the jaundice persists, or if other symptoms are present. These disorders include:

1. biliary atresia
2. ABO incompatibility (similar to a transfusion reaction, caused when
3. fetal and maternal blood mingle before birth)
4. Rh incompatibility (Anti-Rh antibodies)
5. galactosemia (see galactosemia screen)
6. cephalhematoma
7. polycythemia
8. glucose-6-phosphate dehydrogenase deficiency
9. neonatal sepsis
10. congenital cytomegalovirus infection (CMV)
11. congenital toxoplasmosis
12. congenital syphilis
13. congenital herpes
14. congenital rubella
15. late pregnancy administration of sulfa drugs to the mother
16. Crigler-Najjar syndrome
17. spherocytosis (congenital hemolytic anemia)
18. cystic fibrosis
19. breastmilk jaundice
20. pyruvate kinase deficiency
21. thalassemia
22. Gilbert's syndrome
23. congenital hypothyroidism
24. Lucey-Driscol syndrome
25. Gaucher's disease
26. Niemann-Pick disease

Non-pathogenic:

1. Early onset 2nd to 5^th day (breast feeding jaundice)
2. Late onset 5^th to 10 days (breast milk jaundice)

Characterestics:

0. It appears in the 1^st week of life- 2^nd to 5^th day it peaks on day 4^th
1. Bilirubin level rarely exceeds 17mg\dl
2. It lasts for 1-2 wks
3. Etiology infrequent breast feeding- because it increases entero-hepatic circulation

Management:

• frequent feedings day and night 8-12 times/day
• avoid water or glucose water
• unable to suckle- express milk and feed to the baby

Breast milk jaundice:

Characterestics:

0. It appears towards the end of 1^st wk of life-usually 5^th to 10 days of age-peak 5^th to 15^th day
1. Duration 3wks to 3 months
2. Bilirubin level may exceed 20mg/dl
3. Etiology: still unknown may be due to:

1-Increased entero hepatic circulation or

2- Presence of certain substance in the breast milk

4. Currently it is a diagnosis of exclusion

Management:

• If bilirubin > 20mg/dl brief interruption of breast feeding (12-48 hours )
• Photo therapy
• Exchange transfusion – rarely required