NEONATAL JAUNDICE: Approach To Indirect Hyperbilirubinemia

Neonatal Jaundice Check Bilirubin Indirect (Unconjugated) Hyperbilirubinemia (<20% direct) Physiologic Onset within first week of life Never in first 24 hours Clinically well Pathologic Onset anytime within first week Red Flags: Onset in first 24 hours Clinically unwell Risk factors present Pathologic Indirect Hyperbilirubinemia Increased Bilirubin Production Non-Hemolytic Cephalohematoma Polycythemia Hemolytic* Extrinsic Immune mediated (Isoimmunization ABO, Rh disease) Sepsis (bacteremia, UTI, meningitis) Intrinsic Membrane defects (spherocytosis, elliptocytosis) Enzyme deficiencies (G6PD deficiency) Decreased Bilirubin Clearance Breast milk jaundice Gilbert’s syndrome Crigler-Najjar syndrome Direct (Conjugated) Hyperbilirubinemia (>20% direct) Refer to: Neonatal Jaundice: Approach to Direct Hyperbilirubinemia Causes: ↑ Enterohepatic circulation GI obstruction Breastfeeding jaundice / dehydration