Pediatric Jaundice

Pediatric/Neonatal jaundice is a yellowish discoloration of the white part of the eyes and skin in a newborn baby due to high bilirubin levels. Other symptoms may include surplus sleepiness or poor feeding. Difficulties may include seizures, cerebral palsy, or kernicterus.

In many cases there is no specific underlying disorder (physiologic). In other cases it significances from red blood cell cessation, liver disease, infection, hypothyroidism, or metabolic complaints (pathologic). A bilirubin level more than 34 μmol/l (2 mg/dL) may be visible. Concerns, in otherwise healthy babies, occur when levels are greater than 308 μmol/L (18 mg/dL), jaundice is noticed in the first day of life, there is a quick rise in levels, jaundice lasts more than two weeks, or the baby appears unwell. In those with concerning findings further investigations to determine the underlying cause are recommended.

The need for treatment depends on bilirubin levels, the age of the child, and the underlying cause. Treatments may include more frequent feeding, phototherapy, or exchange transfusions.

Causes

In neonates, jaundice tends to progress because of two factors—the breakdown of fetal hemoglobin as it is swapped with adult hemoglobin and the relatively immature metabolic pathways of the liver, which are unable to conjugate and so defecate bilirubin as quickly as an mature. This causes an accumulation of bilirubin in the blood (hyperbilirubinemia), leading to the signs of jaundice.

If the neonatal jaundice does not resolve with simple phototherapy, other causes such as biliary atresia, Progressive familial intrahepatic cholestasis, bile duct paucity, Alagille syndrome, alpha 1-antitrypsin deficiency, and other pediatric liver diseases should be considered.

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