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Neonatal jaundice- Incidence ~85% of term newborns
Bili levels are EXPECTED to rise during first 5 days of life
Be aware of CONJUGATED hyperbilirubinemias (biliary atresia, infection)
Majority of cases due to increase in unconjugated (indirect) bilirubin 2/2 residual fHgb breakdown and insufficient capacity of hepatic conjugation
Severe hyperbilirubinemia (Tbili >20mg/dL) <2% of term infants
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Acute bilirubin encephalopathy(ABE)- Hypertonia, arching, opisthotonos, fever, high pitched cry
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Kernicterus (5% of ABE)-CP, MR, auditory dysfunction, upward gaze palsy
When to refer for phototherapy/exchange transfusion
- Reference published guides (attached)
- Online calculator- http://bilitool.org/
References
“Evaluation and Treatment of Neonatal Hyperbilirubinemia” Muchowski MD, Naval Hospital Camp Pendleton Family Medicine Residency Program, Camp Pendleton, California; Am Fam Physician. 2014 Jun 1;89(11):873-878.
Management of Hyperbilirubinemia in the Newborn Infant35 ore More Weeks of Gestatiion, Pediatrics 2004 July; 114(1)