TEALE FENNING

bronwyn · Posted: Sun Oct 29, 2006 7:54 pm Post subject: Causes of neonatal jaundice

Causes by time of onset in a term infant

A. Jaundice onset between days 1 to 14 of life

1. See Causes below

B. Jaundice onset within first 24 hours

1. Neonatal Sepsis
a. Pneumonia
b. Meningitis
c. Urinary Tract Infection
2. Necrotizing enterocolitis (NEC)
3. Streptococcal or Staphylococcal Skin Infections
4. Herpes simplex viremia
5. Toxoplasmosis
6. Rubella
7. Occult hemorrhage
8. Erythroblastosis Fetalis

C. Jaundice onset after 2 weeks of life

1. Persistent Late-Onset Breast Milk Jaundice
2. Sepsis
3. Hypothyroidism and other metabolic disorders

Normal Physiologic Neonatal Jaundice

A. Normal Physiologic Jaundice
B. Exaggerated Physiologic Jaundice
C. Breast Milk Jaundice

Overproduction of Bilirubin (Indirect Hyperbilirubinemia)

A. Increased Hemolysis Causes (Anemia and Reticulocytosis)

1. Coombs positive
a. Fetal Hydrops from Rh Sensitization
b. Anti-Kell
c. Anti-Duffy
d. ABO incompatibility

2. Coombs negative
a. Red Blood Cell membrane defect (e.g. Spherocytosis)
b. Red Blood Cell enzyme defect (e.g. G6PD Deficiency)
c. Abnormal Red Blood Cell (Hemoglobinopathy)

B. Non-hemolytic causes (No Reticulocytosis)

1. Birth Trauma
a. Intraventricular Hemorrhage in Preterm Infants
b. Cephalohematoma

2. Polycythemia
a. Fetal-maternal transfusion
b. Twin-Twin Transfusion

3. Ileus

4. Cystic Fibrosis

5. Pyloric stenosis

6. Breast Milk Jaundice

Decreased Conjugation (Indirect Hyperbilirubinemia)

A. Familial nonhemolytic Jaundice
1. Crigler-Najjar Syndrome (Type 1 and type 2)

B. Gilbert's Disease (Gilbert Syndrome)

C. Hypothyroidism

D. Prematurity

E. Breast Milk Jaundice

Decreased Excretion (Direct Hyperbilirubinemia)
A. Obstruction
1. Biliary atresia
2. Dubin-Johnson Syndrome
3. Rotor's Syndrome
4. Choledochal cyst
5. Cystic Fibrosis
6. Tumor or amniotic band
B. Infection
1. Sepsis
2. Tuberculosis
3. Toxoplasmosis
4. Herpes Simplex Virus
5. Rubella
6. Syphilis
C. Metabolic Causes
1. Galactosemia
2. Glycogen Storage Diseases
3. Tyrosinosis
4. Hypermethioninemia
5. Drug related causes
a. Novobiocin
b. Pregnanediol
c. Lucey-Driscoll Syndrome
6. Maternal Diabetes Mellitus
7. Hypopituitarism
D. Genetic disorders
1. Turner's Syndrome
2. Trisomy 18
3. Trisomy 21
E. Medications: Miscellaneous
1. Aspirin
2. Acetaminophen
3. Alcohol
4. Corticosteroids
F. Antibiotics
1. Sulfa
2. Rifampin
3. Erythromycin
4. Tetracycline
_________________
Bronwyn Bell
SpR
Portsmouth