Highlights & Basics
- Neonatal jaundice is usually noted clinically when serum bilirubin is >5 mg/dL. Occurs in 60% to 70% of term neonates. Most cases are physiologic.
- Jaundice in the first 24 hours of life is considered pathologic.
- Treatment for hyperbilirubinemia may include phototherapy and if more severe, exchange transfusion.
- The major complication of unconjugated hyperbilirubinemia is kernicterus.
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History & Exam
Key Factors
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Definition
Epidemiology
Etiology
Pathophysiology
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Metabolic pathway of bilirubin with pathologies relating to unconjugated hyperbilirubinemia. 1. ABO incompatibility, Rhesus incompatibility, shorter RBC lifespan in neonates, bruising during delivery; 2. induced by inflammatory mediators associated with comorbidities of prematurity (e.g., respiratory distress syndrome, infection); 3. dissociation increased by acidosis, ketosis, renal failure; 4. permeable blood-brain barrier in term neonates and premature babies; 5. mutation in UGT1A1 gene results in Gilbert syndrome or Crigler-Najjar syndrome I and II; 6. unconjugated bilirubin load increased by decreased gut motility
Detail of liver lobule and its functions, highlighting pathologies that cause conjugated hyperbilirubinemia. Pathologies include: 1. portal vein thrombosis; 2. choledochal cyst; 3. infection (sepsis, E coli urinary tract infection, hepatitis A or B, toxoplasmosis, cytomegalovirus, syphilis, herpes), metabolic (Rotor syndrome, galactosemia, tyrosinemia, alpha-1 antitrypsin deficiency, hypothyroidism, cystic fibrosis, Zellweger syndrome), drugs, idiopathic neonatal hepatitis, total parenteral nutrition, neonatal hemochromatosis, shock/hypoxia/ischemia; 4. bile duct paucity, biliary atresia, Alagille syndrome, idiopathic neonatal cholestasis, progressive familial intrahepatic cholestasis, inspissated bile syndrome; 5. MRP2 (also known as ABCC2) gene mutations on the canalicular membrane of hepatocytes result in Dubin-Johnson syndrome, absence of OATP1B1 and OATP1B3 at the sinusoidal membrane of hepatocytes result in Rotor syndrome
Citations
Kemper AR, Newman TB, Slaughter JL, et al. Clinical practice guideline revision: management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation. Pediatrics. 2022 Sep 1;150(3):e2022058859.[Full Text]
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Slaughter JL, Kemper AR, Newman TB. Technical report: Diagnosis and management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation. Pediatrics. 2022 Sep 1;150(3):e2022058865.[Abstract][Full Text]
Gu J, Zhu Y, Zhao J. The efficacy of intravenous fluid supplementation for neonatal hyperbilirubinemia: a meta-analysis of randomized controlled studies. J Matern Fetal Neonatal Med. 2019 Nov 17;1-6.[Abstract]
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