Facts for MRCOG by Mr.V.Ravimohan,MS,MRCOG

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
excessive haemoloysis-average fetal haemoglobin is higher than neonatal haemoglobin.
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 jaundice,

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:E medicine Wikipaedia
useful powerpoint presentation:Neonatal Jaundice

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