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- Debra H. Pan, MD*
- Yolanda Rivas, MD*
- *Division of Pediatric Gastroenterology and Nutrition, The Children’s Hospital at Montefiore, Bronx, NY
AUTHOR DISCLOSURE
Drs Pan and Rivas have disclosed no financial relationships relevant to this article. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.
- AAP:
- American Academy of Pediatrics
- ALT:
- alanine aminotransferase
- AST:
- aspartate aminotransferase
- BA:
- biliary atresia
- BUGT:
- bilirubin uridine diphosphate-glucuronosyltransferase
- GALD:
- gestational alloimmune liver disease
- GGT:
- γ-glutamyl transpeptidase
- G6PD:
- glucose-6-phosphate dehydrogenase
- Ig:
- immunoglobulin
- IVIg:
- intravenous Ig
- MCT:
- medium-chain triglyceride
- MR:
- magnetic resonance
- MRCP:
- MR cholangiopancreatography
- PFIC:
- progressive familial intrahepatic cholestasis
- PN:
- parenteral nutrition
- PT:
- prothrombin time
- TORCH:
- toxoplasmosis, other (syphilis, varicella-zoster, parvovirus B19), rubella, cytomegalovirus, and herpes simplex
Education Gap
Neonatal jaundice is a common clinical sign that indicates hyperbilirubinemia. Clinicians should become familiar with the differential diagnoses of hyperbilirubinemia in newborns and young infants and the importance of early referral of all patients with cholestatic jaundice to a pediatric gastroenterologist or hepatologist.
Objectives
After completing this article, readers should be able to:
Recognize jaundice as a sign of hyperbilirubinemia and identify risk factors for neonatal jaundice.
Explain bilirubin metabolism.
Define hyperbilirubinemia and differentiate between the types of hyperbilirubinemia in newborns and young infants.
Explain the broad differential diagnoses of neonatal jaundice.
Recognize the importance of screening and postdischarge follow-up to prevent severe unconjugated hyperbilirubinemia.
Describe the management of neonatal jaundice, including cholestasis.
The term jaundice, derived from the French word jaune, meaning yellow, is a yellowish discoloration of the skin, sclerae, and mucous membranes that is caused by tissue deposition of pigmented bilirubin. Jaundice is also known as icterus, from the ancient Greek word ikteros, signifying jaundice. Jaundice is a common clinical sign in newborns, especially during the first 2 weeks after birth. The first description of neonatal jaundice and bilirubin staining of the newborn brain goes back to the eighteenth century. The finding of jaundice on physical examination is an indicator of hyperbilirubinemia. This differs from carotenemia, which can also manifest as a pale yellow-red skin color and is caused by a high level of carotene in the blood.
Older children and adults have a normal total serum bilirubin level less than 1.5 mg/dL (26 μmol/L), with the conjugated fraction accounting for less than 5%. (1) Hyperbilirubinemia is defined as a total serum bilirubin level greater than 1.5 …
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