Before You See an Infant with Jaundice

In this episode, we discuss things you’ll need to know and think about before seeing an infant with jaundice. We will focus on infants from birth to 2 months of age. We will discuss the pathophysiology of hyperbilirubinemia, the difference between unconjugated and conjugated hyperbilirubinemia, the differential diagnosis, key elements of the history and physical exam, laboratory and imaging workup, and management. Introduction to jaundice and hyperbilirubinemia Jaundice is the yellowing of skin, sclerae, and mucous membranes caused by hyperbilirubinemia Hyperbilirubinemia can be further separated into unconjugated or conjugated forms, which allows us to further differentiate etiology Review of bilirubin breakdown pathway, to include enterohepatic circulation Unconjugated hyperbilirubinemia etiologies: Excessive or increased production of bilirubin Cephalohematomas Hemolysis: ABO and Rh incompatibilities; Red Blood Cell (RBC) membrane or enzyme defects, RBC oxidative stress (secondary to sepsis, asphyxia, and acidosis) Decreased clearance of bilirubin Breast milk jaundice Prematurity Hypothyroidism Gilbert Syndrome Crigler-Najjar Syndrome Suboptimal Intake Jaundice Medications Combination of both Physiologic jaundice Conjugated hyperbilirubinemia etiologies: Always pathologic Biliary atresia Briefly mentioned the vast range of other etiologies: infectious, genetic, metabolic, and anatomic Key elements of history and physical examination for a jaundiced infant History: Onset Feeding patterns (what, how much/often, quality of feeding) Urine and stool diapers Prenatal history Delivery history Family history Physical exam:<...

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