Description
Neonatal jaundice is characterized clinically by a yellowish discoloration of the skin, sclera, and mucous membrane and is caused by high total serum bilirubin (TSB). Unconjugated bilirubin's negative effects on the central nervous system are particularly dangerous for preterm infants and those born with congenital enzyme impairments. If left untreated, severe hyperbilirubinemia may produce acute and chronic bilirubin encephalopathy and bilirubin-induced neurological impairment.
Summary Listen
- Neonatal jaundice, or hyperbilirubinemia, is a common condition where total serum bilirubin exceeds the 95th percentile for age, resulting in yellow discoloration of the skin, mucous membranes, and sclera. It's prevalent in 60% of term and 80% of preterm babies during their first week of life, often requiring readmission after birth.
- Bilirubin metabolism involves the catabolism of heme proteins, primarily hemoglobin, converted to bilirubin with the help of heme oxygenase. Unconjugated bilirubin binds to albumin and is transported to the liver, where it undergoes conjugation via UDP glucuronosyltransferase, mainly UGT1A1. Conjugated bilirubin is then excreted into the bile and intestines.
- In neonates, lower intestinal microbiota and increased beta-glucuronidase activity lead to deconjugation and reabsorption of bilirubin, contributing to physiological jaundice. This, combined with decreased UGT1A1 enzyme expression, further increases unconjugated bilirubin levels.
- Etiology ranges from physiological jaundice to pathological conditions, including hemolytic disorders (ABO/Rh incompatibility, RBC membrane defects), increased enterohepatic circulation (breastfeeding/milk jaundice, intestinal obstruction), and decreased conjugation (Gilbert/Crigler-Najjar syndrome, hypothyroidism). Pathological jaundice is suspected if jaundice appears on day 1, palms/soles are yellow, bilirubin rises rapidly, or direct bilirubin is elevated.
- Diagnosis involves thorough history, physical examination, and appropriate lab evaluations. Lab tests include total and direct bilirubin, complete blood count, peripheral smear, reticulocyte count, Coombs test, and G6PD analysis. An algorithmic approach helps differentiate between direct and indirect hyperbilirubinemia and guides further investigations.
- Management includes phototherapy and exchange transfusion, guided by age-specific nomograms. Phototherapy uses blue light to convert bilirubin into a water-soluble form. IVIG can be used in cases of isoimmune hemolytic disease to reduce hemolysis. It's crucial to differentiate neonatal jaundice from cholestasis, which requires prompt referral and care.
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About the Speakers
Dr Vishal Parmar
MBBS, DCH, MRCPCH,Fellow in Neonatal Medicine,PGPN Bostan Pediatrician Mumbai, India.
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