What are the reasons for neonatal jaundice
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neonatal jaundice causes physiologic pathologic AAP
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Neonatal jaundice is caused by increased bilirubin in the blood. It is usually unconjugated (indirect) bilirubin, because newborns produce more bilirubin, have an immature liver that clears it less efficiently, and reabsorb more bilirubin from the intestine. ROSEN's Emergency Medicine, p. 3225.
Common causes
1. Physiologic jaundice
- Normal transitional newborn process
- Usually appears after 24 hours, peaks around days 3-5 in term infants, then improves
- More common and often more pronounced in preterm infants
2. Feeding-related jaundice
- Breastfeeding jaundice: inadequate milk intake in the first days of life, causing dehydration, reduced stooling, and increased bilirubin reabsorption.
- Breast-milk jaundice: develops later in otherwise well, adequately fed breastfed babies; may persist for several weeks.
3. Increased red-cell breakdown, causing excess bilirubin
- ABO or Rh blood-group incompatibility
- G6PD deficiency
- Hereditary red-cell disorders
- Birth trauma, bruising, cephalohematoma
- Polycythemia, meaning an unusually high red-cell count
4. Prematurity
- Immature liver bilirubin conjugation and often reduced feeding efficiency.
5. Infection or illness
- Sepsis
- Urinary tract infection
- Congenital infections, such as CMV
- Hypoxia, acidosis, or poor circulation can worsen jaundice.
6. Reduced bilirubin processing
- Congenital hypothyroidism
- Genetic disorders such as Crigler-Najjar or Gilbert syndrome
- Some medications
7. Liver or bile-flow disease, usually direct/conjugated jaundice
- Biliary atresia
- Neonatal hepatitis
- Alpha-1 antitrypsin deficiency
- Metabolic disorders
- Cholestasis associated with severe illness or parenteral nutrition
Direct (conjugated) hyperbilirubinemia is always abnormal and needs prompt assessment. Merck's neonatal hyperbilirubinemia review similarly distinguishes physiologic, feeding-related, hemolytic, and liver-related causes.
Concerning features
Urgent medical evaluation is needed if jaundice:
- starts in the first 24 hours of life
- is rapidly worsening or reaches the palms and soles
- persists beyond 2 weeks
- occurs with poor feeding, lethargy, fever, vomiting, or high-pitched crying
- is associated with dark urine or pale/white stools, which can indicate cholestasis or biliary atresia.
Recent systematic reviews retrieved were focused on detection or treatment rather than causes, so they do not materially change this etiologic framework (PMIDs: 38785728, 40540314).
Give the nenotal tests and give in timings to do the test in how many days including the hearing test heel blood test, g6pd all tests
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Newborn screening schedules and the heel-prick panel differ by country and hospital. Which country is the baby in?
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