Neonatal Jaundice Questions & Answers

Updated: Dec 27, 2017
  • Author: Thor WR Hansen, MD, PhD, MHA, FAAP; Chief Editor: Muhammad Aslam, MD  more...
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Questions & Answers

Overview

What is neonatal jaundice?

When was neonatal jaundice first identified?

What is the pathogenesis of neonatal jaundice?

What is the role of bilirubin in the pathophysiology of neonatal jaundice?

What is the role of endogenous and exogenous binding competitors in the pathogenesis of neonatal jaundice?

What is the role of ligandin in the pathogenesis of neonatal jaundice?

What is the role of uridine diphosphoglucuronyltransferase (UDPGT) in the pathogenesis of neonatal jaundice?

What is the role of bilirubin conjugation in the pathogenesis of neonatal jaundice?

Which infants are at an increased risk of significant hyperbilirubinemia and neonatal jaundice?

What is the enterohepatic circulation cycle and which infants have an increased risk of developing jaundice through this mechanism?

What is breast milk jaundice and which genetic factors increase the risk of developing it?

Which factors increase the risk for neonatal jaundice?

What are the challenges to measuring total serum bilirubin values in neonatal jaundice?

What is difference between physiologic and pathologic neonatal jaundice?

What is the role of bilirubin clearance in the etiology of breast feeding jaundice?

What are the risk factors for neonatal jaundice?

What is the incidence of neonatal jaundice in the US?

What is the global incidence of neonatal jaundice?

Does the incidence of neonatal jaundice vary among racial or ethnic groups?

Is there a gender predilection for neonatal jaundice?

Does the risk for neonatal jaundice vary by gestational age?

What is the prognosis of neonatal jaundice?

What is the incidence of kernicterus in neonatal jaundice?

How should parents be educated about neonatal jaundice?

How can parents detect early neonatal jaundice in their newborns?

Presentation

What is the timing for the appearance of neonatal jaundice?

What is the focus of family history in cases of neonatal jaundice?

What information is elicited from history of pregnancy and delivery in cases of neonatal jaundice?

Which details of postnatal history should be obtained for neonatal jaundice?

How is neonatal jaundice initially identified?

What is the significance of cephalocaudal progression in neonatal jaundice?

What are physical findings of neonatal jaundice?

What immediate actions should be taken if neurologic symptoms are present in neonatal jaundice?

Which conditions may exacerbate neonatal jaundice?

DDX

What are important considerations in healthy full-term neonates with neonatal jaundice?

Which conditions may cause nonphysiologic jaundice in neonates?

What are the differential diagnoses for Neonatal Jaundice?

Workup

How should bilirubin be measured in neonates?

Which conditions may require additional testing during evaluation of neonatal jaundice?

Which studies are performed if the rate of rise or the absolute bilirubin concentration is approaching the need for phototherapy for neonatal jaundice?

What is the role of ultrasonography in the evaluation of neonatal jaundice?

What is the role of radionuclide scanning in the evaluation of neonatal jaundice?

What is the role of an automated auditory brainstem response (AABR) study in the evaluation of neonatal jaundice?

What is the role of brainstem auditory evoked potentials (BAEPs) in the evaluation of neonatal jaundice?

Do phonetic characteristics of an infant's cry have a role in the evaluation of neonatal jaundice?

What do yellow organs indicate in the evaluation of neonatal jaundice?

Treatment

What are the indications for surgical care or specialist consultations in the management of neonatal jaundice?

When is double and triple phototherapy indicated for the treatment of neonatal jaundice?

What are the treatment options for neonatal jaundice?

What is the primary treatment for neonatal jaundice?

Why is phototherapy effective treatment for neonatal jaundice?

What are the benefits of phototherapy for the treatment of neonatal jaundice?

How is phototherapy administered for the treatment of neonatal jaundice?

Is green light more effective than blue or white light for the treatment of neonatal jaundice?

What are the advantages and disadvantages of blue fluorescent tubes in phototherapy for the treatment of neonatal jaundice?

What are the advantages and disadvantages of white (daylight) fluorescent tubes in phototherapy for the treatment of neonatal jaundice?

Are white quartz lamps effective phototherapy for the treatment of neonatal jaundice?

What are the advantages and disadvantages of using fiber optic lights in phototherapy for neonatal jaundice?

What are the advantages and disadvantages of using light-emitting diode (LED) lights in phototherapy for neonatal jaundice?

At what total serum bilirubin level is the risk of neurotoxicity increased in patients with neonatal jaundice?

Is the risk for bilirubin encephalopathy increased in premature infants with neonatal jaundice?

What is the historical role of exchange transfusion in the treatment of neonatal jaundice?

When is exchange transfusion indicated for the treatment of neonatal jaundice?

Why is scientific data from randomized studies limited for neonatal jaundice?

What is the primary measure of risk for bilirubin encephalopathy in neonatal jaundice?

What are the limitations of the available guidelines for the management of neonatal jaundice?

Does the serum bilirubin value that triggers phototherapy and exchange transfusion in neonatal intensive care units (NICUs) vary for the treatment of neonatal jaundice?

What is the emphasis of the AAP guidelines for the management of hyperbilirubinemia in healthy full-term newborns?

What are the recommended guidelines for the treatment of neonatal jaundice?

What are the Neonatal Subgroup of the Norwegian Pediatric Society guidelines for the treatment of neonatal jaundice?

What were the published results of the Neonatal Research Network (NRN) phototherapy trial for the treatment of neonatal jaundice?

What should be considered in the administration of phototherapy for the treatment of neonatal jaundice?

What are the possible adverse effects and complications of phototherapy for treating neonatal jaundice?

What is the role of IVIG in the treatment of neonatal jaundice?

What are the AAP guidelines for IVIG dosing in the treatment of neonatal jaundice?

When is an exchange transfusion indicated for the treatment of neonatal jaundice?

How common is exchange transfusion for the treatment of neonatal jaundice?

Why is an early exchange transfusion performed for the treatment of neonatal jaundice?

Which serum bilirubin level triggers an exchange transfusion in infants with hemolytic jaundice?

What should be considered when selecting treatment for neonatal jaundice?

What are the AAP guidelines for the treatment selection in neonatal jaundice?

What is the risk for neurotoxicity in hemolytic jaundice?

What are the techniques for exchange transfusion for neonatal jaundice?

What is the management of infants readmitted with extreme jaundice?

What is the role of hydration in the management of neonatal jaundice?

Are there protocols for the rapid evaluation and management of neonatal jaundice?

What is the crash-cart approach to treatment of acute bilirubin encephalopathy (ABE)?

What is the efficacy of a crash-cart approach to management of infants with extreme jaundice?

What is the role of breastfeeding in the management of neonatal jaundice?

Are oral bilirubin oxidase, agar or charcoal feeds effective treatments for neonatal jaundice?

Which prophylactic measure has decreased the incidence and severity of Rh-hemolytic disease in neonatal jaundice?

Can breastfeeding increase the risk of neonatal jaundice?

What are the guidelines recommendations for monitoring for neonatal jaundice in newborns released within the first 48 hours of life?

Which infants are at higher risk of developing significant jaundice?

What is the AAP guidelines recommendation for screening for neonatal jaundice prior to discharge?

What are the risk factors for hyperbilirubinemia in neonatal jaundice?

What is the efficacy of telephone consultations for monitoring of neonatal jaundice?

Have new devices for transcutaneous measurement of bilirubin levels facilitated monitoring for neonatal jaundice?

What is the role of home phototherapy for the treatment of neonatal jaundice?

What is the protocol for monitoring of infants who received treatment for hemolytic jaundice?

How is severe neonatal jaundice prevented?

Which tool is available for distinguishing infants with a low risk of subsequently developing neonatal jaundice?

What are clinical risk factors for neonatal jaundice?

Medications

Which medications are administered for infants with physiologic neonatal jaundice?

Is IVIG an effective treatment for neonatal jaundice?

What is the role of bilirubin production inhibition via metal mesoporphyrins and protoporphyrins in the treatment of neonatal jaundice?

What is the role of supplementation of probiotics in the treatment of neonatal jaundice?

What is the role of zinc sulfate supplementation in the treatment of neonatal jaundice?

Follow-up

When can infants treated for neonatal jaundice be discharged?

What is the protocol for transfer of infants with neonatal jaundice in need of exchange transfusion?

Should phototherapy be continued while exchange transfusion is performed for the treatment of neonatal jaundice?