Causes of neonatal jaundice Clinical features UNCONJUGATED Rhesus haemolysis Onset within 24 hr Hydrops, severely anaemic and hepatosplenomegaly

Coombes (DAT) test positive Onset within 24 hr Haemolysis is less severe than rhesus disease and hepatosplenomegaly is absent. Coombes (DAT) test positive Onset within 24 hr Autosomal dominant Coombes (DAT) test negative Splenomegaly Splenectomy after the age of 5 to prevent destruction of rbc Onset within 24 hr Usually caused by TORCH infections CMV retinitis, thrombocytopaenia, hepatosplenomegaly, periventricular calcifications Toxoplasmosis tram-like calcifications, hepatosplenomegaly Poor fluid intake, haemolysis, reduced hepatic function and an increase in the enterohepatic circulation. UTIs may present this way. Reflects temporary inadequacy of immature liver Onset 24h-2 weeks Mild symptoms which completely resolves without treatment Skin or scalp bruising (cephalohaematoma) enzyme glucuronyl transferase is deficient or absent may result in extremely high levels of unconjugated bilirubin. Can be prolonged lasting >2weeks in full term (>3w in pre-term babies) Diagnosis of exclusion: Baby is thriving May present with prolonged jaundice before the clinical features of coarse facies, dry skin, hypotonia and constipation become evident. Affected infants should be identified on Guthrie test More than 10% of total bilirubin or >20mcmol/L Always pathological. Phototherapy CANNOT be used as treatment Early onset Persistant and rising levels of conjugated bilirubin. Associated pale stools and dark urine. Urgent referral Causing cholestasis Associated mental retardation Autosomal recessive Inability to excrete organic anions into bile

ABO haemolysis

Hereditary Spherocytosis

Congenital infection

Bacterial septicaemia Physiological

Haemolysis secondary to haematoma Crigler Najjer syndrome Breast milk jaundice Gilberts disease Congenital hypothyroidism CONJUGATED Congenital infection (TORCH) Bacterial septicaemia Biliary atresia CF Dublin-Johnson syndrome Rotors syndrome Metabolic causes: galactosaemia, alpha 1 anti trypsin deficiency)