NEONATAL JAUNDICE CAUSES HISTORY
Category: Child Health
Abstract : History (neonatal jaundice): • Presentation and duration o Typically,
presentation is on the second or third day of life. o Jaundice that is
visible during the first 24 hours of life is highly likely to be nonphysiologic
jaundice and requires further evaluation. o Similarly, infants presenting
with jaundice after the third day of life may require closer scrutiny. o In
History (neonatal jaundice):
• Presentation and duration
o Typically,
presentation is on the second or third day of life.
o Jaundice that is
visible during the first 24 hours of life is highly likely to be nonphysiologic
jaundice and requires further evaluation.
o Similarly, infants presenting
with jaundice after the third day of life may require closer scrutiny.
o In
infants with severe jaundice or jaundice that continues beyond the first week of
life, further family history should be explored.
• Family history
o
Previous sibling with jaundice in the neonatal period
o Other family members
with jaundice
o Anemia, splenectomy, or bile stones in family members
o
Liver disease
• History of pregnancy and delivery
o Maternal illness
suggestive of viral or other infection
o Maternal drug intake
o Delayed
cord clamping
o Birth trauma with bruising
• Postnatal history
o
Loss of stool color
o Breastfeeding
o Symptoms of
hypothyroidism
Physical (neonatal jaundice):
• Neonatal jaundice first
becomes visible in the face and forehead. Identification is aided by pressure on
the skin, since blanching reveals the underlying color. Jaundice then gradually
becomes visible on the trunk and extremities. This cephalocaudal (or
cephalopedal) progression is well described, even in 19th-century medical texts.
Jaundice disappears in the opposite direction. This phenomenon is clinically
useful because, independently of other factors, visible jaundice in the feet may
be an indication to check the serum bilirubin level.
• In most infants,
yellow color is the only finding on physical examination. More intense jaundice
may be associated with drowsiness. Brainstem auditory evoked potentials
performed at this time may reveal prolongation of latencies, decreased
amplitudes, or both.
• Overt neurologic findings, such as changes in
muscle tone, seizures, or altered crying characteristics, in a significantly
jaundiced infant are danger signs and require immediate attention to avoid
kernicterus.
• Hepatosplenomegaly, petechiae, and microcephaly are
associated with hemolytic anemia, sepsis, and congenital infections and should
precipitate diagnostic evaluation directed towards these diagnoses. Neonatal
jaundice may be exacerbated in these situations, but it does not cause the
findings.
Causes (neonatal jaundice):
• Physiologic jaundice is caused
by a combination of increased bilirubin production secondary to accelerated
destruction of erythrocytes, decreased excretory capacity secondary to low
levels of ligandin in hepatocytes, and low activity of the bilirubin-conjugating
enzyme UDPGT.
• Pathologic neonatal jaundice occurs when additional
factors are superimposed on the basic mechanisms described above. Such is the
case in immune or nonimmune hemolytic anemia and in polycythemia.
•
Decreased clearance of bilirubin may play a role in breast milk jaundice and in
several metabolic and endocrine disorders.
• Risk factors
o Race:
Incidence is higher in East Asians and American Indians and is lower in African
Americans.
o Geography: Incidence is higher in populations living at high
altitudes. Greeks living in Greece have a higher incidence than those living
outside of Greece.
o Genetics and familial risk: Incidence is higher in
infants with siblings who had significant neonatal jaundice. Incidence also is
higher in infants with mutations in the gene coding for UDPGT (Gilbert syndrome)
and/or in infants with homozygous or heterozygous G-6-PD deficiency.
o
Nutrition: Incidence is higher in infants who are breastfed.
o Maternal
factors: Infants of mothers with diabetes have higher incidence. Use of some
drugs may increase incidence, while others decrease incidence.
o Birthweight
and gestational age: Incidence is higher in premature infants and/or in infants
with low birthweight.
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