An approach to

neonatal jaundice at
CE

Sharad

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Introduction
 Neonatal jaundice is

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 Topics of Discussion
 Causes of neonatal jaundice.

 Investigations done for it.

 Review of literature,guidelines for investigations of

NNP.

 What investigations would be appropriate at CE.?

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 Causes: Early <10 days.Haemolytic diseases,infection
Late >10 days.Breast milk jaundice,infection,
Hepatobiliary and metabolic

Mechanism Causes Investigations

Early Jaundice Rhesus DCT,Mothers/infants Bl
[<10 days] Gr
a) First 24 Hr ABO incompatibility Microspherocytes
Immune haemolysis. Rare Blood Gr Ab.

Non-immune
haemolysis G6PD,PK Deficiency Family H/o
Congenital G6PD essay
Spherocytosis Blood Film

sepsis Fbc , and septic

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Mechanism Causes investigations
b) After 24 Hrs;[<10 days]
Physiological J. Prematurity, History,
Delayed maturation of Hypoglycemia Bl Glucose ,
Conjugating Hypoxia PaO2
enzymes,bilirubin
Dehydration History
overload.
Intestinal stasis Examination.

Excess Bil Production

Bruising/cephal. Examination
DIC, Polycythemia, DIC screen, HCT
Ingested mat Bld
Infection
IVH U/s
Sepsis Septic screen
Cong non haemolytic
TORCH IgM for TORCH
causes
Crigler Najjar,Gilberts Usually diagnosed
later,family H/o

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Mechanism Cause Investigation
Metoblic Galactosemia Urine reducing
Substance.

II Prolonged Jn(>10 D)
Prolonged UC Jn
Breast milk Breast Milk jaundice Trial of formula milk
Lucy Driscoll Synd.
Sepsis FBC, septic screen
Metabolic Hypothyroid TSH,Thyroxin
Amnioacedemias Plasma/urine amino
Galactosaemia Urine reducing subs
Fructosaemia LFTs
Cystic fibrosis IrT
^EHC IO,Pyloric St,Atresia AXR,U/S
meconium ileus/plug
Underfeeding,fasting,
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Mechanism Cause Investigation
>10 Days
Persistent Rh [inspissated
haemolysis bile syndrome]
Hb-pathy,G6PD,
PK,vit E def.
Congenital CNS and
nonhaemolytic Gilberts
hyperbilirubinemia

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Mechanism Cause Investigations
2]Prolonged UC
hyperbil >10 D:
Intrahepatic
Cholestasis Septicaemia,UTI, Septic
Ac infections listeriosis screen,urine c/s

Cong[IU]infections TORCH TORCH screen,

viral markers
Metabolic
Disorders
Alfa1 antritrypsin Alfa-1-antitrypsin
def phenotyping
Cystic fibrosis IrT sweat test
Galactossemia,
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fructossemia subs, LFTs.
Mechanism Cause Investigations
Peroxisomal Zellweger Serum catalase
disorders Syndrome
Disorder of BA syn Dubin Johnson
Rotor
Biliary hypoplasia Alagille’s X-ray spine
Syndrome

Extra hepatic BA Radio isotopic

cholestatsis Choledochal Cyst scan,U/s
Endocrine ¬Thyroid, TSH,T4,
¬pitutary ACTH,
¬adrenalism 170HProgesteron
e, Cortisol,
TPN IH Cholestasis,
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hepatitis