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.

Expert consensus: Patient profile should guide antihistamine choice in primary care setting

10 Dec 2019

Oral H₁-antihistamines are the initial treatment of choice for allergic rhinitis (AR) and chronic urticaria in the primary care setting. However, in a diverse population of patients with AR and urticaria, primary care physicians are faced with the challenge of prescribing the best therapy amid a wide armamentarium of antihistamines available.

Countering the menace of the common cold with zinc

13 Jun 2017

The common cold is one of the most widespread illness and is a leading cause of visits to the doctor and absenteeism from school and work. While many may see it as merely a harmless inconvenience, the significant repercussions it brings, especially among children cannot be denied. MIMS JPOG recently spoke to Associate Professor Datin Dr Asmiati Abd Hamid to gain her perspectives on the role of zinc and vitamin C in treating paediatric common cold to reduce morbidity and economic losses attributed to the condition.

How nutrition and parental influence support child development

13 Jun 2017

In an exclusive interview with MIMS Doctor, Dr Yong Junina Fadzil, a consultant paediatrician and paediatric cardiologist at Klinik Pakar Kanak-Kanak Junina shared her perspectives on the roles of balanced nutrition and parental influence in child development.