NEONATAL JAUNDICE: Approach To Indirect Hyperbilirubinemia

Neonatal Jaundice Check bilirubin (If > 2 weeks, check total AND direct) <20% direct >20% direct Indirect (unconjugated) hyperbilirubinemiaDirect (conjugated) Hyperbilirubinemia See “Neonatal Jaundice: Approach to Direct Hyperbilirubinemia” Pre-hepatic Physiologic* Onset within first week of life, never in first 24 hours Clinically well Pathologic Onset anytime within first week of life Red flags: Onset first 24 hrs of life, clinically unwell, risk factors present Increased bilirubin production Decreased bilirubin clearance Increased enterohepatic circulation Non-hemolytic Cephalohematoma Polycythemia Hemolytic* Extrinsic Intrinsic Breast milk Jaundice* Gilbert’s Criglar Najar GI obstruction Breastfeeding jaundice/dehydration* *Indicates Key Condition This is not an exhaustive list of medical conditions. Immune mediated Isoimmunization (ABO, Rh disease) Sepsis* (bacteremia, UTI, meningitis, other) Membrane (spherocytosis, elliptocytosis) Enzyme (G6PD, pyruvate kinase deficiency)