The normal infant Jaundice Incidence
Very common. About 50%of full-term infants and 80% of preterm infants are visibly jaundiced by 3 ?5 days of age.
Pathology ?Early jaundice occurring within 24 ?48 h of birth is usually due to abnormal haemolysis,infection,or bruising.
?Physiological jaundice appears after 48 h of age and usually subsides within 7 ?10 days.It is mainly unconjugated bilirubin due to increased red cell destruction and immaturity of hepatic enzymes.
?Prolonged jaundice lasting beyond 14 days is sometimes seen in normal preterm or breast-fed infants, but other conditions should be excluded, especially hypothyroidism, galactosaemia,liver disease, red cell enzyme eefects and biliary atresia.
Clinical Yellow staining of the skin and conjunctivae. features Hepatosplenomegaly indicates the presence of abnormal haemolysis,infection or a metabolic disorder and is not found in physiological jaundice.
Significance Very severe unconjugated hyperbilirubinaemia may cause permanent brain damage (kernicterus)with athetoid cerebral palsy and sensorineural deafness.
Management Observe jaundice clinically and monitor plasma bilirubin level. Investigation may be required if jaundice appears earlier than 48 h,is prolonged beyond 14 days or is unusually high at any stage. Dehydration and drugs such as sulphonamides, which compete with bilirubin for albumin - binding, should be avoided.
There is no evidence that extra fluids are needed or hasten the resolution of jaundice in normal infants.
Phototherapy or exchange transfusion may be required in some infants with high levels of plasma bilirubin. Some jaundiced babies, particularly those with severe rhesus haemolytic disease develop a curious bronze colour under phototherapy.