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| '''For patient information, click [[Neonatal jaundice (patient information)|here]]''' | | '''For patient information, click [[Neonatal jaundice (patient information)|here]]''' |
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| {{DiseaseDisorder infobox | | | {{Neonatal jaundice }} |
| Name = Neonatal jaundice |
| | {{CMG}} '''Assosciate Editor(s)-In-Chief:''' [[User: Prashanthsaddala|Prashanth Saddala M.B.B.S]], {{AEL}}, |
| Image = |
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| Caption = Infant undergoing home phototherapy for jaundice using a [[bili light|bili blanket]] |
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| ICD10 = {{ICD10|P|58||p|50}}, {{ICD10|P|59||p|50}} |
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| ICD9 = {{ICD9|773}}, {{ICD9|774}} |
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| OMIM = |
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| MedlinePlus = 001559 |
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| eMedicineSubj = |
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| eMedicineTopic = |
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| DiseasesDB = 8881 |
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| }}
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| {{SI}}
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| {{CMG}}
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| ==Overview==
| | '''''Synonyms and Keywords:''''' Jaundice of the newborn; Neonatal hyperbilirubinemia |
| '''Neonatal jaundice''' is a yellowing of the [[skin]] and other tissues of a newborn [[infant]] caused by increased levels of [[bilirubin]] in the [[blood]]. Neonatal jaundice is usually harmless: this condition is often seen in infants around the second day after birth, lasting till day 8 in normal births, or to around day 14 in premature births. Serum bilirubin normally drops to a low level without any intervention required: the jaundice is presumably a consequence of metabolic and physiological adjustments after birth. | |
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| All [[jaundice]] should be medically evaluated before treatment can be given.
| | ==[[Neonatal jaundice overview|Overview]]== |
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| ==Causes== | | ==[[Neonatal jaundice historical perspective|Historical Perspective]]== |
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| In neonates, benign jaundice tends to develop because of two factors - the breakdown of [[fetal hemoglobin]] as it is replaced with [[Hemoglobin|adult hemoglobin]] and the relatively immature hepatic metabolic pathways which are unable to conjugate and so excrete bilirubin as fast as an adult. This causes an accumulation of bilirubin in the body ([[hyperbilirubinemia]]), leading to the symptoms of jaundice.
| | ==[[Neonatal jaundice classification|Classification]]== |
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| Severe neonatal jaundice may indicate the presence of other conditions contributing to the elevated bilirubin levels, of which there are a large variety of possibilities (see below). These should be detected or excluded as part of the [[differential diagnosis]] to prevent the development of complications. They can be grouped into the following categories:
| | ==[[Neonatal jaundice pathophysiology|Pathophysiology]]== |
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| {{familytree/start}}
| | ==[[Neonatal jaundice causes|Causes]]== |
| {{familytree | | | | | | | | | | | | | A01 | | | | |A01=Neonatal jaundice}}
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| {{familytree | | | | | | | | |,|-|-|-|-|^|-|-|-|-|.|}}
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| {{familytree | | | | | | | | B01 | | | | | | | | B02|B01=[[Unconjugated bilirubin]]|B02=[[Conjugated bilirubin]]}}
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| {{familytree | | | | | |,|-|-|^|-|-|.| | | |,|-|-|^|-|-|.| |}}
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| {{familytree | | | | | C01 | | | | C02 | | C03 | | | | C04 | |C01=[[pathology|Pathologic]] |C02=[[Physiologic]] |C03=[[Hepatic]] |C04=Post-hepatic}}
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| {{familytree | | |,|-|-|^|-|-|.| | | | | | | | | | | |}}
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| {{familytree | | C01 | | | | C02 | | | | | | | | | | | |C01=[[hemolysis|Hemolytic]]|C02=Non-hemolytic}}
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| {{familytree | | |)|-|-|-|-|-|.| | | | | | | | | | | |}}
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| {{familytree | | C01 | | | | C02 | | | | | | | | | | | |C01=Intrinsic causes|C02=Extrinsic causes}}
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| {{familytree/end}}
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| ===Intrinsic causes of hemolysis=== | | ==[[Neonatal jaundice differential diagnosis|Differentiating Neonatal jaundice from other Diseases]]== |
| *Membrane conditions
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| **[[Spherocytosis]]
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| **[[Hereditary elliptocytosis]]
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| *Systemic contitions
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| **[[Splenomegaly]]
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| **[[Sepsis]]
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| **[[Arteriovenous malformation]]
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| *Enzyme conditions
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| **[[Glucose-6-phosphate dehydrogenase deficiency]] (also called G6PD deficiency)
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| **[[Pyruvate kinase deficiency]]
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| *Globin synthesis defect
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| **[[Alpha-thalassemia]]
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| ===Extrinsic causes of hemolysis=== | | ==[[Neonatal jaundice epidemiology and demographics|Epidemiology and Demographics]]== |
| *[[Alloimmunity]] (The neonatal or [[cord blood]] gives a positive [[Coombs test#Direct Coombs test|direct Coombs test]] and the maternal blood gives a positive [[Coombs test#Indirect Coombs est|indirect Coombs test]])
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| **[[Hemolytic disease of the newborn (ABO)]]
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| **[[Rh disease]]
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| **[[Hemolytic disease of the newborn (anti-Kell)]]
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| **[[Hemolytic disease of the newborn (anti-Rhc)]]
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| **Other blood type mismatches causing [[hemolytic disease of the newborn]]
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| ===Non-hemolytic causes=== | | ==[[Neonatal jaundice risk factors|Risk Factors]]== |
| *[[Cephalohematoma]]
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| *[[Polycythemia]]
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| *[[Sepsis]]
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| *[[Hypothyroidism]]
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| *[[Gilbert's syndrome]]
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| *[[Crigler-Najjar syndrome]]
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| ===Hepatic causes=== | | ==[[Neonatal jaundice screening|Screening]]== |
| *Infections
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| **[[Sepsis]]
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| **[[Hepatitis B]], [[TORCH syndrome|TORCH infections]]
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| *Metabolic
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| **[[Galactosemia]]
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| **[[Alpha-1-antitrypsin deficiency]]
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| **[[Cystic fibrosis]]
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| *Drugs
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| *[[Total parenteral nutrition]]
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| *Idiopathic
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| ===Post-hepatic=== | | ==[[Neonatal jaundice natural history, complications and prognosis|Natural History, Complications and Prognosis]]== |
| *[[Biliary atresia]]
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| *[[Bile duct]] obstruction
| | ==Diagnosis== |
| | [[Neonatal jaundice diagnostic study of choice|Diagnostic Study of Choice]] | [[Neonatal jaundice history and symptoms| History and Symptoms]] | [[Neonatal jaundice physical examination | Physical Examination]] | [[Neonatal jaundice laboratory findings|Laboratory Findings]] | [[Neonatal jaundice electrocardiogram|Electrocardiogram]] | [[Neonatal jaundice x ray|X Ray]] | [[Neonatal jaundice CT|CT]] | [[Neonatal jaundice MRI|MRI]] | [[Neonatal jaundice ultrasound|Echocardiography or Ultrasound]] | [[Neonatal jaundice other imaging findings|Other Imaging Findings]] | [[Neonatal jaundice other diagnostic studies|Other Diagnostic Studies]] |
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| ==Treatment== | | ==Treatment== |
| Infants with neonatal jaundice are often treated with [[bili light]]s, exposing them to high levels of colored light to break down the bilirubin. This works due to a photo oxidation process occurring on the bilirubin in the subcutaneous tissues of the neonate. Light energy creates isomerization of the bilirubin and consequently transformation into compounds that the new born can excrete via urine and stools. Blue light is typically used for this purpose. Green light is more effective at breaking down bilirubin, but is not commonly used because it makes the babies appear sickly, which is disturbing to observers. A recent study has shown that light therapy may increase the risk of skin moles (or "[[nevi]]") in childhood which in turn also increases the risk of [[melanoma]] (skin cancer).<ref>{{cite web |url=http://www.medpagetoday.com/HematologyOncology/SkinCancer/tb/4730 |title=Childhood Moles Linked to Neonatal Jaundice Treatment - CME Teaching Brief� - MedPage Today |accessdate=2007-06-30 |format= |work=}}</ref><ref>{{cite web |url=http://www.medicinenet.com/script/main/art.asp?articlekey=78650 |title=Infant Jaundice Treatment May Encourage Moles - Skin diseases, conditions and procedures on MedicineNet.com |accessdate=2007-06-30 |format= |work=}}</ref>
| | [[Neonatal jaundice medical therapy|Medical Therapy]] | [[Neonatal jaundice surgery|Surgery]] | [[Neonatal jaundice primary prevention|Primary Prevention]] | [[Neonatal jaundice secondary prevention|Secondary Prevention]] | [[Neonatal jaundice cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Neonatal jaundice future or investigational therapies|Future or Investigational Therapies]] |
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| Brief exposure to '''indirect''' sunlight each day and increased feeding are also helpful. A newborn should not be exposed to direct [[sunlight]] because of the danger of [[sunburn]], which is much more harmful to a newborn's thin skin than that of an adult.
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| If the neonatal jaundice does not clear up with simple [[phototherapy]], other causes such as [[biliary atresia]], PFIC, bile duct paucity, Alagille's syndrome, alpha 1 and other pediatric liver diseases should be considered. The evaluation for these will include blood work and a variety of diagnostic tests. Prolonged neonatal jaundice is serious and should be followed up promptly.
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| ==Non-organic causes== | | ==Case Studies== |
| ===Breast feeding jaundice===
| | [[Neonatal jaundice case study one|Case#1]] |
| "Breastfeeding jaundice" is caused by insufficient milk intake resulting in dehydration, and can be prevented by frequent breastfeeding sessions of sufficient duration to stimulate adequate milk production.
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| ===Breast milk jaundice=== | | ==Related Chapters== |
| Very rarely, "breast milk jaundice" occurs during the second or third week of life, and may be caused by high levels of [[beta-glucuronidase]] in [[breast milk]]. Neither condition is a reason to stop nursing, though caregivers may advise IV or other fluid administration to ensure the baby is not dehydrated.
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| ==Non-physiologic causes==
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| A small percentage of infants will have "hemolytic jaundice". The infant's red blood cells will be broken down quicker because antibodies that attack the infant's red blood cells are transferred from the mother to the baby's bloodstream. The antibodies may be due to [[ABO]] (blood group) incompatibility or [[Rhesus factor]] differences. <ref>{{cite web |url=http://pediatrics.about.com/od/weeklyquestion/a/04_abo_incmplty.htm |title=ABO Incompatibility |accessdate=2007-06-30 |format= |work=}} at About.com</ref>
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| ==Rare causes==
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| Rarely, neonatal jaundice may be caused by a [[Genetics|genetic]] [[syndrome]] such as [[Crigler-Najjar syndrome]].
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| ==Complications==
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| With high doses of bilirubin (severe hyperbilirubinemia) there can be a complication known as [[kernicterus]]. This is the chief condition that treatment of jaundice is aimed at preventing. The effects of kernicterus range from fever, seizures, and a high-pitched crying to mental retardation. This is due to a staining effect on the [[basal ganglia]] leading to neuronal damage. With aggressive treatment such as exchange transfusion to lower very high bilirubin levels, the neurological effects are almost always transient.
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| ==See also==
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| * [[Jaundice]] | | * [[Jaundice]] |
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| ==References==
| | {{WH}} |
| {{reflist|2}} | | {{WikiDoc Sources}} |
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| {{Certain conditions originating in the perinatal period}}
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| {{SIB}}
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| | [[Category:Medicine]] |
| | [[Category:Gastroenterology]] |
| | [[Category:Up-To-Date]] |
| [[Category:Pediatrics]] | | [[Category:Pediatrics]] |
| [[Category:Hepatology]] | | [[Category:Hepatology]] |
| [[Category:Hematology]] | | [[Category:Hematology]] |
| [[Category:Neonatology]]
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| [[Category:Overview complete]]
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| [[Category:Disease state]]
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| [[de:Neugeborenengelbsucht]]
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| [[es:Ictericia del recién nacido]]
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| {{WH}}
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| {{WikiDoc Sources}}
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