![]() ‘Too Long’ (> 10 days of age, especially > 2 weeks) What it is in breast milk that causes excessive jaundice is not known but unsaturated fatty acids or a lipase, which inhibits glucuronyl transferase have been suspected. Breast-milk jaundiceįrom as early as the third day of life, the SBR concentration of breastfed infants is higher than those who are formula-fed. Infections acquired early in pregnancy may cause neonatal hepatitis, but other clinical signs are obvious and a substantial fraction of the jaundice is conjugated (> 15 per cent). If the baby has other signs as well as excessive jaundice, acute bacterial infection must be excluded (particularly urinary tract infection). increased enterohepatic circulation (such as bowel obstruction).infection - a more likely cause during this time.breakdown of extravasated blood (for example, cephalhaematoma, bruising, CNS haemorrhage, swallowed blood).haemolysis - continuing causes as discussed under ‘too early’.mild dehydration/insufficient milk supply (breastfeeding jaundice).If the SBR concentration exceeds 200-250 micromol/L, over this time, various causes include: CRP to assist with diagnosis of infection.full blood examination, looking for evidence of haemolysis, unusually-shaped red cells, or evidence of infection.elution test to detect anti-A or anti-B antibodies on baby's red cells (more sensitive than the direct Coombs test).direct antiglobulin test (Coombs) test (detects antibodies on the baby's red cells).maternal blood group and antibody titres.Investigation of early pathological jaundice This may or may not occur in Rh babies who have had in-utero transfusions. ‘Too early’ ( 15 per cent of the total), consider hepatitis. Pathological jaundice is best considered in relation to time of birth. increased enterohepatic circulation of bilirubin.Īs the name implies, physiological jaundice is common and harmless.decreased uptake and binding by liver cells.macrosomic infant of a diabetic mother.previous sibling requiring phototherapy.Minor risk factors for hyperbilirubinaemia are: family history of red cell enzyme defects (such as G6PD deficiency) or red cell membrane defects (such as hereditary spherocytosis).weight loss greater than 10 per cent of birthweight may be associated with ineffective breastfeeding.cephalhaematoma or significant bruising.previous sibling requiring phototherapy for haemolytic disease.blood group incompatibility particularly Rhesus (Rh) incompatibility.Major risk factors for severe hyperbilirubinaemia are: Risk factors for developing severe hyperbilirubinaemia Major risk factors Sunlight exposure is no longer recommended as a treatment for jaundice due to risk of sunburn or overheating.SBR from a capillary sample is assumed to be the same as that from a venous sample.Serum albumin level does not need to be measured in addition to the bilirubin to determine management. ![]() Total SBR level should be used to determine management decisions in cases of predominantly unconjugated hyperbilirubinaemia.However, visual estimation of the degree of jaundice may be inaccurate, particularly in darkly pigmented newborns. Increasing total serum bilirubin (SBR) levels are accompanied by the cephalocaudal progression of jaundice, predictably from the face to the trunk, extremities and finally to the palms and soles.Jaundice may not be visible in the neonate's skin until the bilirubin concentration exceeds 70-100 micromol/L.Early detection of jaundice (appears in the sclera with SBR of 35-40 micromol/L) may be difficult in newborns because eyelids are often swollen and usually closed.If inadequately managed, jaundice may result in severe brain injury or death. ![]() A few babies will become deeply jaundiced and require investigation and treatment. Jaundice occurs in approximately 60 per cent of newborns, but is unimportant in most neonates. ![]() We recommend that you also refer to more contemporaneous evidence in the interim. Please note that all guidance is currently under review and some may be out of date. ![]()
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