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Nonphysiologic Neonatal Jaundice

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3. Jaundice in Newborns

Aka: Jaundice in Newborns , Neonatal Jaundice , Neonatal Hyperbilirubinemia , Newborn Jaundice From Related Chapters II. Epidemiology Jaundice in full term infants: 60% Jaundice in s: 80% III. Pathophysiology: Physiologic Jaundice See Mechanisms of physiologic Neonatal Jaundice Increased production (2-3 fold over older infants) High fetal turn-over (short half-life) Impaired conjugation Immature hepatic glucuronosyl transferase Decreased excretion Physiologic Transient limitation of conjugation (...) of severe ) Confirming observation with transcutaneous or is preferred Obtain Transcutaneous or Obtain based on risk (preferred method) See (score of 8 or more indicates testing) Often part of hospital directed universal screening (e.g. all newborns at 24 hours) Universal screening is controversial Estimated to cost >$5 million in U.S. annually to prevent a single case of Increases rates without evidence that it decreases the risk of Obtain for Neonatal Jaundice in the first 24 hours Neonatal Jaundice

2018 FP Notebook

4. Jaundice in Newborns

Aka: Jaundice in Newborns , Neonatal Jaundice , Neonatal Hyperbilirubinemia , Newborn Jaundice From Related Chapters II. Epidemiology Jaundice in full term infants: 60% Jaundice in s: 80% III. Pathophysiology: Physiologic Jaundice See Mechanisms of physiologic Neonatal Jaundice Increased production (2-3 fold over older infants) High fetal turn-over (short half-life) Impaired conjugation Immature hepatic glucuronosyl transferase Decreased excretion Physiologic Transient limitation of conjugation (...) of severe ) Confirming observation with transcutaneous or is preferred Obtain Transcutaneous or Obtain based on risk (preferred method) See (score of 8 or more indicates testing) Often part of hospital directed universal screening (e.g. all newborns at 24 hours) Universal screening is controversial Estimated to cost >$5 million in U.S. annually to prevent a single case of Increases rates without evidence that it decreases the risk of Obtain for Neonatal Jaundice in the first 24 hours Neonatal Jaundice

2015 FP Notebook

5. Bilirubin, Impaired Conjugation (Follow-up)

of pharmacogenetics in Gilbert syndrome has yet to be determined. Although impaired glucuronidation and excretion of certain drugs have been reported, such impairment has not resulted in any adverse clinical events, and the risk probably remains more theoretical than real. [ , ] Neonatal jaundice No treatment is needed for physiologic jaundice. For breast milk jaundice and other types of nonphysiologic jaundice, phototherapy can be used. Phototherapy, which consists of exposing the infant's skin to light (...) . [ ] In a study of 200 jaundiced neonates at or over 35 weeks' gestation who were phototherapy candidates, use of a super LED bed achieved significantly higher success rates of intensive phototherapy (87%) compared with conventional intensive phototherapy with triple fluorescent tube units (64%). There was also a significantly greater reduction in bilirubin levels for both hemolytic and nonhemolytic subgroups in the super LED bed treatment group than in similar subgroups that received standard intensive

2014 eMedicine.com

6. Glucuronyl Transferase Deficiency (Diagnosis)

cramps, fatigue, and malaise, are common Physiologic neonatal jaundice - Clinically obvious in 50% of neonates during the first 5 days of life Nonphysiologic neonatal jaundice - Maternal serum jaundice, also known as Lucey-Driscoll syndrome, is an autosomal recessive metabolic disorder affecting enzymes involved in bilirubin metabolism; it causes a transient familial neonatal unconjugated hyperbilirubinemia, and jaundice occurs during the first 4 days of life See for more detail. Diagnosis Crigler (...) with this condition is unjustified in clinical practice. Neonatal jaundice No treatment is needed for physiologic jaundice. For breast milk jaundice and other types of nonphysiologic jaundice, phototherapy can be used. See and for more detail. Next: Background Unconjugated hyperbilirubinemia can result from increased production, impaired , or impaired hepatic uptake of bilirubin, a yellow bile pigment produced from hemoglobin during erythrocyte destruction. It can also occur naturally in newborns. (See

2014 eMedicine Pediatrics

7. Crigler-Najjar Syndrome (Follow-up)

of pharmacogenetics in Gilbert syndrome has yet to be determined. Although impaired glucuronidation and excretion of certain drugs have been reported, such impairment has not resulted in any adverse clinical events, and the risk probably remains more theoretical than real. [ , ] Neonatal jaundice No treatment is needed for physiologic jaundice. For breast milk jaundice and other types of nonphysiologic jaundice, phototherapy can be used. Phototherapy, which consists of exposing the infant's skin to light (...) . [ ] In a study of 200 jaundiced neonates at or over 35 weeks' gestation who were phototherapy candidates, use of a super LED bed achieved significantly higher success rates of intensive phototherapy (87%) compared with conventional intensive phototherapy with triple fluorescent tube units (64%). There was also a significantly greater reduction in bilirubin levels for both hemolytic and nonhemolytic subgroups in the super LED bed treatment group than in similar subgroups that received standard intensive

2014 eMedicine.com

8. Crigler-Najjar Syndrome (Diagnosis)

, and malaise, are common Physiologic neonatal jaundice - Clinically obvious in 50% of neonates during the first 5 days of life Nonphysiologic neonatal jaundice - Maternal serum jaundice, also known as Lucey-Driscoll syndrome, is an autosomal recessive metabolic disorder affecting enzymes involved in bilirubin metabolism; it causes a transient familial neonatal unconjugated hyperbilirubinemia, and jaundice occurs during the first 4 days of life See for more detail. Diagnosis Crigler-Najjar syndrome type 1 (...) in clinical practice. Neonatal jaundice No treatment is needed for physiologic jaundice. For breast milk jaundice and other types of nonphysiologic jaundice, phototherapy can be used. See and for more detail. Next: Background Unconjugated hyperbilirubinemia can result from increased production, impaired , or impaired hepatic uptake of bilirubin, a yellow bile pigment produced from hemoglobin during erythrocyte destruction. It can also occur naturally in newborns. (See and .) Biochemistry of bilirubin

2014 eMedicine.com

9. Bilirubin, Impaired Conjugation (Diagnosis)

cramps, fatigue, and malaise, are common Physiologic neonatal jaundice - Clinically obvious in 50% of neonates during the first 5 days of life Nonphysiologic neonatal jaundice - Maternal serum jaundice, also known as Lucey-Driscoll syndrome, is an autosomal recessive metabolic disorder affecting enzymes involved in bilirubin metabolism; it causes a transient familial neonatal unconjugated hyperbilirubinemia, and jaundice occurs during the first 4 days of life See for more detail. Diagnosis Crigler (...) with this condition is unjustified in clinical practice. Neonatal jaundice No treatment is needed for physiologic jaundice. For breast milk jaundice and other types of nonphysiologic jaundice, phototherapy can be used. See and for more detail. Next: Background Unconjugated hyperbilirubinemia can result from increased production, impaired , or impaired hepatic uptake of bilirubin, a yellow bile pigment produced from hemoglobin during erythrocyte destruction. It can also occur naturally in newborns. (See

2014 eMedicine.com

10. Gilbert Syndrome (Diagnosis)

, and malaise, are common Physiologic neonatal jaundice - Clinically obvious in 50% of neonates during the first 5 days of life Nonphysiologic neonatal jaundice - Maternal serum jaundice, also known as Lucey-Driscoll syndrome, is an autosomal recessive metabolic disorder affecting enzymes involved in bilirubin metabolism; it causes a transient familial neonatal unconjugated hyperbilirubinemia, and jaundice occurs during the first 4 days of life See for more detail. Diagnosis Crigler-Najjar syndrome type 1 (...) in clinical practice. Neonatal jaundice No treatment is needed for physiologic jaundice. For breast milk jaundice and other types of nonphysiologic jaundice, phototherapy can be used. See and for more detail. Next: Background Unconjugated hyperbilirubinemia can result from increased production, impaired , or impaired hepatic uptake of bilirubin, a yellow bile pigment produced from hemoglobin during erythrocyte destruction. It can also occur naturally in newborns. (See and .) Biochemistry of bilirubin

2014 eMedicine.com

11. Bilirubin, Impaired Conjugation (Treatment)

of pharmacogenetics in Gilbert syndrome has yet to be determined. Although impaired glucuronidation and excretion of certain drugs have been reported, such impairment has not resulted in any adverse clinical events, and the risk probably remains more theoretical than real. [ , ] Neonatal jaundice No treatment is needed for physiologic jaundice. For breast milk jaundice and other types of nonphysiologic jaundice, phototherapy can be used. Phototherapy, which consists of exposing the infant's skin to light (...) . [ ] In a study of 200 jaundiced neonates at or over 35 weeks' gestation who were phototherapy candidates, use of a super LED bed achieved significantly higher success rates of intensive phototherapy (87%) compared with conventional intensive phototherapy with triple fluorescent tube units (64%). There was also a significantly greater reduction in bilirubin levels for both hemolytic and nonhemolytic subgroups in the super LED bed treatment group than in similar subgroups that received standard intensive

2014 eMedicine.com

12. Crigler-Najjar Syndrome (Treatment)

of pharmacogenetics in Gilbert syndrome has yet to be determined. Although impaired glucuronidation and excretion of certain drugs have been reported, such impairment has not resulted in any adverse clinical events, and the risk probably remains more theoretical than real. [ , ] Neonatal jaundice No treatment is needed for physiologic jaundice. For breast milk jaundice and other types of nonphysiologic jaundice, phototherapy can be used. Phototherapy, which consists of exposing the infant's skin to light (...) . [ ] In a study of 200 jaundiced neonates at or over 35 weeks' gestation who were phototherapy candidates, use of a super LED bed achieved significantly higher success rates of intensive phototherapy (87%) compared with conventional intensive phototherapy with triple fluorescent tube units (64%). There was also a significantly greater reduction in bilirubin levels for both hemolytic and nonhemolytic subgroups in the super LED bed treatment group than in similar subgroups that received standard intensive

2014 eMedicine.com

13. Hyperbilirubinemia, Unconjugated (Treatment)

of pharmacogenetics in Gilbert syndrome has yet to be determined. Although impaired glucuronidation and excretion of certain drugs have been reported, such impairment has not resulted in any adverse clinical events, and the risk probably remains more theoretical than real. [ , ] Neonatal jaundice No treatment is needed for physiologic jaundice. For breast milk jaundice and other types of nonphysiologic jaundice, phototherapy can be used. Phototherapy, which consists of exposing the infant's skin to light (...) . [ ] In a study of 200 jaundiced neonates at or over 35 weeks' gestation who were phototherapy candidates, use of a super LED bed achieved significantly higher success rates of intensive phototherapy (87%) compared with conventional intensive phototherapy with triple fluorescent tube units (64%). There was also a significantly greater reduction in bilirubin levels for both hemolytic and nonhemolytic subgroups in the super LED bed treatment group than in similar subgroups that received standard intensive

2014 eMedicine.com

14. Gilbert Syndrome (Overview)

, and malaise, are common Physiologic neonatal jaundice - Clinically obvious in 50% of neonates during the first 5 days of life Nonphysiologic neonatal jaundice - Maternal serum jaundice, also known as Lucey-Driscoll syndrome, is an autosomal recessive metabolic disorder affecting enzymes involved in bilirubin metabolism; it causes a transient familial neonatal unconjugated hyperbilirubinemia, and jaundice occurs during the first 4 days of life See for more detail. Diagnosis Crigler-Najjar syndrome type 1 (...) in clinical practice. Neonatal jaundice No treatment is needed for physiologic jaundice. For breast milk jaundice and other types of nonphysiologic jaundice, phototherapy can be used. See and for more detail. Next: Background Unconjugated hyperbilirubinemia can result from increased production, impaired , or impaired hepatic uptake of bilirubin, a yellow bile pigment produced from hemoglobin during erythrocyte destruction. It can also occur naturally in newborns. (See and .) Biochemistry of bilirubin

2014 eMedicine.com

15. Bilirubin, Impaired Conjugation (Overview)

cramps, fatigue, and malaise, are common Physiologic neonatal jaundice - Clinically obvious in 50% of neonates during the first 5 days of life Nonphysiologic neonatal jaundice - Maternal serum jaundice, also known as Lucey-Driscoll syndrome, is an autosomal recessive metabolic disorder affecting enzymes involved in bilirubin metabolism; it causes a transient familial neonatal unconjugated hyperbilirubinemia, and jaundice occurs during the first 4 days of life See for more detail. Diagnosis Crigler (...) with this condition is unjustified in clinical practice. Neonatal jaundice No treatment is needed for physiologic jaundice. For breast milk jaundice and other types of nonphysiologic jaundice, phototherapy can be used. See and for more detail. Next: Background Unconjugated hyperbilirubinemia can result from increased production, impaired , or impaired hepatic uptake of bilirubin, a yellow bile pigment produced from hemoglobin during erythrocyte destruction. It can also occur naturally in newborns. (See

2014 eMedicine.com

16. Crigler-Najjar Syndrome (Overview)

, and malaise, are common Physiologic neonatal jaundice - Clinically obvious in 50% of neonates during the first 5 days of life Nonphysiologic neonatal jaundice - Maternal serum jaundice, also known as Lucey-Driscoll syndrome, is an autosomal recessive metabolic disorder affecting enzymes involved in bilirubin metabolism; it causes a transient familial neonatal unconjugated hyperbilirubinemia, and jaundice occurs during the first 4 days of life See for more detail. Diagnosis Crigler-Najjar syndrome type 1 (...) in clinical practice. Neonatal jaundice No treatment is needed for physiologic jaundice. For breast milk jaundice and other types of nonphysiologic jaundice, phototherapy can be used. See and for more detail. Next: Background Unconjugated hyperbilirubinemia can result from increased production, impaired , or impaired hepatic uptake of bilirubin, a yellow bile pigment produced from hemoglobin during erythrocyte destruction. It can also occur naturally in newborns. (See and .) Biochemistry of bilirubin

2014 eMedicine.com

17. Hyperbilirubinemia, Unconjugated (Overview)

cramps, fatigue, and malaise, are common Physiologic neonatal jaundice - Clinically obvious in 50% of neonates during the first 5 days of life Nonphysiologic neonatal jaundice - Maternal serum jaundice, also known as Lucey-Driscoll syndrome, is an autosomal recessive metabolic disorder affecting enzymes involved in bilirubin metabolism; it causes a transient familial neonatal unconjugated hyperbilirubinemia, and jaundice occurs during the first 4 days of life See for more detail. Diagnosis Crigler (...) with this condition is unjustified in clinical practice. Neonatal jaundice No treatment is needed for physiologic jaundice. For breast milk jaundice and other types of nonphysiologic jaundice, phototherapy can be used. See and for more detail. Next: Background Unconjugated hyperbilirubinemia can result from increased production, impaired , or impaired hepatic uptake of bilirubin, a yellow bile pigment produced from hemoglobin during erythrocyte destruction. It can also occur naturally in newborns. (See

2014 eMedicine.com

18. Gilbert Syndrome (Treatment)

of pharmacogenetics in Gilbert syndrome has yet to be determined. Although impaired glucuronidation and excretion of certain drugs have been reported, such impairment has not resulted in any adverse clinical events, and the risk probably remains more theoretical than real. [ , ] Neonatal jaundice No treatment is needed for physiologic jaundice. For breast milk jaundice and other types of nonphysiologic jaundice, phototherapy can be used. Phototherapy, which consists of exposing the infant's skin to light (...) . [ ] In a study of 200 jaundiced neonates at or over 35 weeks' gestation who were phototherapy candidates, use of a super LED bed achieved significantly higher success rates of intensive phototherapy (87%) compared with conventional intensive phototherapy with triple fluorescent tube units (64%). There was also a significantly greater reduction in bilirubin levels for both hemolytic and nonhemolytic subgroups in the super LED bed treatment group than in similar subgroups that received standard intensive

2014 eMedicine.com

19. Hyperbilirubinemia, Unconjugated (Follow-up)

of pharmacogenetics in Gilbert syndrome has yet to be determined. Although impaired glucuronidation and excretion of certain drugs have been reported, such impairment has not resulted in any adverse clinical events, and the risk probably remains more theoretical than real. [ , ] Neonatal jaundice No treatment is needed for physiologic jaundice. For breast milk jaundice and other types of nonphysiologic jaundice, phototherapy can be used. Phototherapy, which consists of exposing the infant's skin to light (...) . [ ] In a study of 200 jaundiced neonates at or over 35 weeks' gestation who were phototherapy candidates, use of a super LED bed achieved significantly higher success rates of intensive phototherapy (87%) compared with conventional intensive phototherapy with triple fluorescent tube units (64%). There was also a significantly greater reduction in bilirubin levels for both hemolytic and nonhemolytic subgroups in the super LED bed treatment group than in similar subgroups that received standard intensive

2014 eMedicine.com

20. Gilbert Syndrome (Follow-up)

of pharmacogenetics in Gilbert syndrome has yet to be determined. Although impaired glucuronidation and excretion of certain drugs have been reported, such impairment has not resulted in any adverse clinical events, and the risk probably remains more theoretical than real. [ , ] Neonatal jaundice No treatment is needed for physiologic jaundice. For breast milk jaundice and other types of nonphysiologic jaundice, phototherapy can be used. Phototherapy, which consists of exposing the infant's skin to light (...) . [ ] In a study of 200 jaundiced neonates at or over 35 weeks' gestation who were phototherapy candidates, use of a super LED bed achieved significantly higher success rates of intensive phototherapy (87%) compared with conventional intensive phototherapy with triple fluorescent tube units (64%). There was also a significantly greater reduction in bilirubin levels for both hemolytic and nonhemolytic subgroups in the super LED bed treatment group than in similar subgroups that received standard intensive

2014 eMedicine.com

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