Classification of Jaundice
1. Physiological jaundice
2. Pathological jaundice
3. Breast milk jaundice
4. Breast feeding jaundice
1. Physiological jaundice/ Icterus Neonatrum
60% of term and 70% of preterm babies develop jaundice within 1st week of life.
In term babies; maximum intensity of jaundice is on 4th day and decline by 7th day.
In term babies; maximum intensity is on 5th-6th day and decline by 14th day.
Causes of Physiological Jaundice
1. Immature hepatic function; increased bilirubin load on liver cells.
a. Increase erythrocyte destruction due to shorter life span (in children 90 days, 120 days in adults
b. Increased Erythrocyte volume
c. Increased enterohepatic circulation of bilirubin
2. Defective bilirubin conjugation
UDPGT activity;uridine diphosphate glucuronosyltransferases
3. Defective hepatic uptake of bilirubin from plasma
1. Decreased cytoplasmic ligandin
2. Decreased serum albumin concentration
2. Breast milk jaundice
Late onset of jaundice.
Begins at age of 5-7 days occurs in 2-3% of breastfed infants.
Peak bilirubin level; during 2nd week and then gradually diminished.
Etiology factor
Caused by breast milk; pregnanediol, fatty acids, beta glucuronidase that either inhibit conjugation or decrease secretion of bilirubin.
Treatment
Increase frequency of breastfeeding.
No supplementation such as glucose water or complementary feeding is given.
3. Brestfeeding jaundice
Early onset of jaundice, begins at 2-4 days of age, occurs in 10-25% of breastfed babies.
Inadequacy of breast feeding results in decreased caloric and fluid intake by breastfed infants before milk supply established.
Fasting causes decrease hepatic clearance of bilirubin resulting in jaundice in inadequately breast fed infants.
Treatment
Frequent Breastfeeding (10-12times/day).
4. Pathological Jaundice (Hemolytic Disease)
Jaundice occuring within 24 hours of birth called pathological jaundice.
In terms; jaundice decline within 10 days
In preterm; jaundice decline within 14 days
Major causes of pathological jaundice is Hemolysis due to ABO/Rh incompatibility and intrauterine infections.
Pathological jaundice Features
1. Clinical jaundice appear within 24 hours of birth.
2. Increase in level of bilirubin by more than 5mg/dl/24hours.
3. Total bilirubin level may be more than 15mg/dl
4. Direct bilirubin >2mg/dl
Etiology of Pathological Jaundice
1. Excessive Red cell hemolysis leading to increased bilirubin production.
2. Hemolytic disease in Newborn
3. Increased red cell fragility
4. G6PD deficiency; Deficient red cell enzyme causing hemolytic anaemia.
5. Neonatal sepsis
2. Metabolic disorders
1. Galactosemia
2. Hypothyroidism
3. Decreased conjugation or decreased clearance
a. Congenital deficiency of hepatic glucuronyl transferase enzyme (Criggler-Najjar syndrome)
b. In preterm baby; impaired liver function
4. Drugs;
Affect binding of bilirubin to Albumin such as; aspirin, sulphonamides.
5. Congenital obstruction or atresia of biliary canal, viral Hepatitis.
Clinical features of Pathological Jaundice
1. Yellow discoloration of skin, sclera or nail bed
2. Lethargy
3. Refusal to food
4. Dark urine and stool
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