MRCOG -Neontal Jaundice part 2

Neonatal jaundice can be broadly categorised into pyhsilogical or pathological jaundice.

Physiological jaundice	pathological jaundice
Jaundice begins 24 hours after birth	Jaundice may start before 24 hours
Jaundice would clear in a week	Jaundice may last even 10 days after birth
Jaundice peaks 48-72 hours	rise rate greater than 5 mg/dL/24 hours
	bilirubin levels greater than 12 mg/dL in full-term infants and 10-14 mg/dL/24 hours in preterm infants

Reason for physiological jaundice
(i)excessive haemoloysis-average fetal haemoglobin is higher than neonatal haemoglobin.
(ii)Hepatic immaturity(In intrauterine life placenta and maternal liver excretes bilirubin)

check this powerpoint presentation:Physiological Jaundice

Classification according to the time of onset

Time of onset	causes
less than 24 hours	haemolysis,sepsis(septicaemia),TORCH
24 hours to 10 days	physiological jaundice, Crigler Najjar syndrome
Onset after 10 days	biliary atresia,breast milk,galactosaemia,hypothyroidism,sepsis(urinary tract infection)

How does hypothyrodism causes neonatal jaundice?

Hypothyroidism slows down the metaboloism, so it would slow down the conjugation of bilirubin.It would cause unconjugated hyperbilirubinaemia.

How does galactosemia causes neonatl jaundice?

Galactosemia is metaboloic disorder caused by absence of enzyme metabolising Galactose.This leads to toxic levels of galactose causing hepatitis,cataract,renal failure and cataracts.One important long term complication is premature ovarian failure.

useful resources:(I)E medicine
(II)Wikipaedia

useful powerpoint presentation:Neonatal Jaundice

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