Neonatal Hyperbilirubinemia

Neonatal jaundice (icterus): yellowing of skin and sclera from elevated bilirubin. Physiologic vs. Pathologic: Physiologic jaundice: - Appears after 24 hours of life (NEVER in first 24 hours) - Peaks: 3–5 days in term; 5–7 days in preterm - Resolves: by 1 week (term), 2 weeks (preterm) - Mechanism: neonatal RBC breakdown + immature hepatic conjugation - Treatment: usually none to phototherapy if levels rise Pathologic jaundice — REQUIRES INVESTIGATION: - Appears in FIRST 24 HOURS (always pathologic — investigate immediately) - Any jaundice in first day of life = hemolysis until proven otherwise - Causes: Rh incompatibility, ABO incompatibility, G6PD deficiency, hereditary spherocytosis Breast milk jaundice: - Appears at 4–7 days; peaks at 10–15 days - Caused by breast milk factor (β-glucuronidase) that increases enterohepatic recirculation - Resolves with continued breastfeeding (do not recommend stopping) - Benign; reassure mother Breastfeeding jaundice (starvation jaundice): - Appears 2–5 days (early) - Caused by inadequate milk intake → delayed stooling → increased enterohepatic circulation - Treatment: improve breastfeeding technique, supplementation if needed Pathologic causes: - Hemolytic disease (Rh, ABO, G6PD) - Sepsis...