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NEONATAL JAUNDICE

Jaundice that appears in a newborn <24 hour old is most likely nonphysiologic and needs further evaluation.
Jaundice typically presents on the 2nd-3rd day of life. It is usually first seen on the face and forehead then progresses caudally to the trunk and extremities.
Visible jaundice in the feet may be an indication to check bilirubin level.
Visual estimation of bilirubin level is often inaccurate and unreliable.
Danger signs in a newborn infant with jaundice includes changes in brainstem evoked auditory potentials, changes in muscle tone, seizures and altered cry characteristics.
The presence of any of the danger signs require prompt attention to prevent kernicterus.

Neonatal%20jaundice Diagnosis

Diagnosis

Jaundice that appears in a newborn <24 hour old is most likely nonphysiologic & needs further evaluation
- Visible jaundice in the feet may be an indication to check bilirubin level

Visual estimation of bilirubin level is often inaccurate & unreliable

Laboratory Tests

Transcutaneous Bilirubinometry (TcB)

A noninvasive way to measure serum bilirubin using handheld devices
May be used as an initial screening test to detect possible development of hyperbilirubinemia
Said to be equivalent to total serum bilirubin & may decrease the need for more invasive TSB measurements; however, more studies may be needed to validate tests that measure TcB

Total Serum Bilirubin (TSB)

Measured if jaundice appears excessive for an infant’s age, when TcB level is >200 µmol/L (12 mg/dL), or if there is any doubt about the degree of jaundice
Often the only test needed for infants who present with moderate jaundice on the 2nd or 3rd day of life & who do not have features suggesting pathologic jaundice

Lab tests for determining cause of jaundice

Lab tests that will be requested will depend on the indications found in an infant
Hematology: Hemoglobin & hematocrit, direct Coomb’s test, peripheral blood film, reticulocyte count, blood type & Rh determination in infant & mother
Screening for G6PD deficiency in infants from high-risk populations
Total & conjugated bilirubin to identify cholestasis
Liver function tests: ALT, AST, GGT, alkaline phosphatase
- A GGT/ALT ratio >1 is highly suggestive of biliary obstruction

Sepsis evaluation in infants who appear ill
- Urinalysis, urine culture
- Tests for parasitic & viral infections

Measurement of end tidal carbon dioxide in breath as an index of bilirubin production
Serum albumin to help evaluate risk of bilirubin toxicity
Thyroid function tests
Imaging of the liver & biliary tract including ultrasonography & radionuclide imaging

Assessment

Clinical Assessment of Severity

Jaundice appears in a cephalo-caudal direction
For clinical assessment, the Kramer’s Rule may be used to estimate the range of indirect bilirubin levels

Area	Level	Indirect Bilirubin
Area	Level	µmol/L	mg/dl
Head & neck	1	68-133	4-8
Upper trunk	2	85-204	5-12
Lower trunk & thighs	3	136-272	8-16
Arms & lower legs	4	187-306	11-18
Palms & soles	5	≥306	≥18

Source: Ministry of Health Malaysia. Clinical practice guidelines: management of neonatal jaundice (second edition). 2015.

A Guide on Primary Immunodeficiency Disease and Allergies

05 Feb 2021

Primary immunodeficiency disease (PIDD) and allergies are two groups of conditions related to the immune system. However, they are uniquely different in terms of symptoms and treatment.