see also: [Safer Care: neonatal jaundice](https://www.safercare.vic.gov.au/clinical-guidance/neonatal/jaundice-in-neonates), [Dunn - Neonatal jaundice](x-devonthink-item://240BD2A9-7CA4-44B7-8F76-3ECC857F7227), [RCH Jaundice](x-devonthink-item://D4DDCB7C-C1D2-4FF2-B574-FC25259188AF), [Newborn jaundice > 35 weeks RWH](x-devonthink-item://C0CE2193-60CD-4CE9-805E-A18056D9FE69)
[[haemolytic disease of newborn]], [[Coombs test]]
> [!Key Points]
> - **physiologic jaundice** around day 2
> - **never normal to have jaundice in first 24H**
> - never normal to have **congugated bilirubinemia**
> - ==test direct and indirect bilirubin==, FBC, blood type, smear (haemolysis), retic count, antibiodies, liver function
>
> **kernicterus:** chronic billirubin encephalopathy
> can cause:
> **Acute** - seizures, coma
> **chronic**: cerebral palsy, developmental delay
\> 18 needs photo therapy
\> 25 (emergency) needs exchange transfusion
> pale stool and conjugated bilirubinaemia is **biliary atresia** until proven otherwise
# Physiologic jaundice
usually elevated **unconguated bilirubin**
- relative dehydration
- breast feeding (inhibits bilirubin congugation)
- infection
# Pathological jaundice
## Too early (<24 hours of age)
- always pathological this early
- ==usually due to haemolysis==
- consider ABO
## too high (24h-10 days of age)
- if bili >200
- think infection Ubut usually dehydration or breast milk)
## Too long (>10 days)
- haemolysis
- inborn errors
- hypothyroidism
> [!TlDR] [mnemonic:: 24-10]
\> <24 hr too early
\> 24-10 too high
\>10 days too long
\>10% congugated bad
\>SBR 100 if can see it on head
exchange >340 if term/well
# unconjugated and congugated hyperbilirubinaemia
| unconjugated | conjugated<br>(always pathological) |
| ------------------------------------------------------------------------------------------------------------------------------------------------------------------ | ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- |
| - *physiological*<br>- prematurity<br>- breast milk<br>- haemolysis<br>- sepsis<br>- hypothyroidism<br>- inborn error of metabolism<br>- grigler najjar, gilbert's | - sepsis<br>- *biliary atresia*<br>- viral infections (TORCH)<br>- hepatitis<br>- cystic fibrosis<br>- alpha 1 anti-trypsin<br>- inborn errors of metabolism<br>- dubin johnson |
| type | timeframe | cause | bili | findings |
| --------------- | --------- | ------------------------------------------------------------------------------------ | --------------------------------------- | -------------------- |
| physiological | day 2-3 | ↑ fetal Hb breakdown | unconjugated | |
| haemolysis | <24 h | - ABO<br>- Rh incompatability<br>- G6PD def<br>- congenital infections<br>- bruising | - can be conjugated or unconjugated<br> | - do [[Coombs test]] |
| sepsis | days 3-7 | bacteria, toxoplasmosis, CMV | | |
| biliary atresia | >1 week | | - conjugated | - pale stools |