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'''Jaundice in children Microchapters'''
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[[Jaundice in children#Overview|Overview]]
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[[Jaundice in children#Historical Perspective|Historical Perspective]]
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[[Jaundice in children#Classification|Classification]]
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[[Jaundice in children#Pathophysiology|Pathophysiology]]
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[[Jaundice in children#Causes|Causes]]
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[[Jaundice in children#Differential Diagnosis|Differential Diagnosis]]
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[[Jaundice in children#Epidemiology and Demographics|Epidemiology and Demographics]]
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[[Jaundice in children#Risk factors|Risk factors]]
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[[Jaundice in children#Natural History, Complications and Prognosis|Natural History, Complications and Prognosis]]
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[[Jaundice in children#Diagnosis|Diagnosis]]
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[[Jaundice in children#Treatment|Treatment]]
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[[Jaundice in children#Prevention|Prevention]]
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{{SI}}                                                                 
{{SI}}                                                                 
{{CMG}} {{AE}}{{Ifeoma Anaya}}
{{CMG}} {{AE}}{{Ifeoma Anaya}}


{{SK}} Jaundice in kids; hyperbilirubinemia
{{SK}} [[Jaundice]] in kids, [[hyperbilirubinemia]]


==Overview==
==Overview==
The word '[[Jaundice]]' is derived from the French word for [[Yellow discolouration|yellow]], which is '''''jaune'''''. [[Jaundice]] may be [[Classification|classified]] into two broad [[categories]] based on its [[Time series|time]] of onset and [[Causes|cause]] such as [[physiologic]] and [[pathologic]] [[jaundice]]. [[Jaundice]] is [[Causes|caused]] by high [[concentrations]] of [[bilirubin]] in the [[bloodstream]], a [[condition]] known as [[hyperbilirubinemia]]. [[Hyperbilirubinemia]] can [[result]] from [[abnormalities]] in the [[metabolism]] of [[bilirubin]] which could occur at any stage from its [[production]], which is a [[result]] of the excessive breakdown of [[red blood cells]], [[Defect|defects]] in its [[hepatic]] [[metabolism]], and its post [[hepatic]] [[Transporter|transport]]. [[Pathologic]] [[causes]] of [[jaundice]] can be [[Classification|classified]] into [[causes]] of [[Conjugated bilirubin|conjugated]] and [[Unconjugated bilirubin|unconjugated]] [[hyperbilirubinemia]]. [[Differentials]] for [[jaundice]] are very limited however, some [[Skin discoloration|skin discolorations]] in [[healthy]] [[Individual growth|individuals]] can look like [[jaundice]] in certain circumstances. The [[prevalence]] of [[jaundice]] varies among [[patient]] [[populations]]. In [[infants]] born at [[term]], 60% will develop [[jaundice]] in their first-week of [[life]], which rises to 80% in [[preterms]]. Common [[risk factors]] in the [[development]] of [[jaundice]] in [[children]] are a [[family history]] of [[jaundice]], [[family history]] of a [[child]] born with [[jaundice]], [[hyperthyroidism]] in the mother, [[medication]] use by the mother, etc. It is essential for every [[clinician]] to note that [[jaundice]] is not always a [[benign]] condition therefore, extensive [[investigation]] of a [[child]] with [[jaundice]] is necessary to [[prevent]] severe [[complications]]. [[Symptoms]] of [[jaundice]] in [[children]] may include the [[Yellow discolouration|yellowish discoloration]] of [[skin]], [[sclera]], and [[mucous membrane]]. A useful [[technique]] in assessing the severity of [[jaundice]] is by using the [[principle]] of [[skin discoloration]] progressing in a cephalo-caudal direction in [[newborns]]. [[Laboratory]] findings include measuring the [[serum bilirubin]] from a [[blood]] sample. The total and [[Conjugated bilirubin|conjugated]] portions are measured and the [[Unconjugated bilirubin|unconjugated fraction]] is measured by subtracting the [[Conjugated bilirubin|conjugated fraction]] from the total. [[Echocardiography]] can detect [[cardiac]] [[abnormalities]] in [[patients]] with [[Alagille syndrome]] and [[biliary atresia]]. [[Ultrasonography]] of the [[abdomen]] is used to [[screen]] for [[biliary atresia]], [[choledochal cysts]], or [[cholestatic]] workup in the setting of [[Conjugated bilirubin|conjugated]] [[hyperbilirubinemia]]. [[Treatment]] options include [[phototherapy]], [[intravenous]] [[immunoglobulin]] ([[IVIG]]), and [[exchange transfusion]]. [[Pharmacological]] options are also there. [[Surgery]] is the mainstay of [[therapy]] or the definitive [[treatment]] for most [[obstructive]] [[causes]] of [[Conjugated bilirubin|conjugated]] [[hyperbilirubinemia]]. Several [[etiologies]] may be generally difficult to [[prevent]] however, the [[prevention]] of [[complications]] from [[jaundice]] is equally crucial. Parents should be educated on how to recognize [[jaundice]] very early in a [[neonate]] so as to present promptly for the management.


==Historical Perspective==
==Historical Perspective==
*The word 'Jaundice' was derived from the french word for yellow which is '''''jaune'''''.<ref name="pmid30422525">{{cite journal| author=| title=StatPearls | journal= | year= 2020 | volume=  | issue=  | pages=  | pmid=30422525 | doi= | pmc= | url= }} </ref>
 
*Earliest known texts of '''''Icterus neonatorum''''' dates back to the medical records of the Providence Lying-in Hospital in the late 19th century. A phenomenon observed amongst several neonates in their first week of stay and attributed to breastfeeding which was the predominant way neonates were fed.
*The word '[[Jaundice]]' is derived from the French word for [[Yellow discolouration|yellow]] which is '''''jaune'''''.<ref name="pmid30422525">{{cite journal| author=| title=StatPearls | journal= | year= 2020 | volume=  | issue=  | pages=  | pmid=30422525 | doi= | pmc= | url= }} </ref>
*A severe form termed '''''Icterus gravis''''' was better understood in the 1940s when advances in immunology and genetics led to the discovery of the Rh group of red cell antigens explaining its frequent recurrences in families after a first child becomes affected. These advances in hemolytic diseases birthed effective treatment modalities and screening methods that included maternal serology and amniocentesis in the perinatal period.  
*Very early records of '''''[[Icterus]] neonatorum''''' date back to the [[medical]] [[records]] of the Providence Lying-in [[Hospital]] in the late 19th century. A feature observed amongst several [[neonates]] in the first week of life and attributed to [[breastfeeding]].
*The Baby Boom Years of the 1960s which was flanked by an increase in birth rates led to the development of the Rh-immune antiglobulin. This was as a result of a corresponding rise in the rate of neonatal jaundice. Thus, Rh erythroblastosis became very rare with screening and immunoglobulin prophylaxis during the antenatal period. <ref>https://www.rimed.org/medhealthri/2010-05/2010-05-154.pdf</ref>
*'''''[[Icterus]] gravis''''', a more dire [[Presenting symptom|presentation]] was better understood in the 1940s when advances in [[immunology]] and [[genetics]] led to the discovery of the [[Rh disease|Rh]] group of [[red cell]] [[antigens]]. It explained its recurrent nature in families after a first [[child]] becomes affected. These advances also led to the [[development]] of [[Effective accessibility|effective]] [[treatment]] modalities along with [[screening]] methods such as [[maternal]] [[serology]] and [[amniocentesis]] in the [[perinatal]] period.
*The principles behind Phototherapy were first discovered at Rochford General Hospital, Essex in the 1950s. Babies taken outside to the warm sunshine with the aim of taking a break from the confines of an incubator literarily became ''less yellow'' than before. Subsequently, lab results further confirmed this discovery. <ref>https://www.viapath.co.uk/news-and-press/the-birth-of-phototherapy</ref>
*An increase in [[birth]] rates during the Baby Boom period of the 1960s enabled the completion of [[clinical trials]] that led to the [[development]] of the [[Rh disease|Rh]]-[[immune]] [[antiglobulin]], following a corresponding rise in the [[rate]] of [[neonatal]] [[jaundice]]. With [[screening]] and [[immunoglobulin]] [[prophylaxis]], Rh [[erythroblastosis]] subsequently became very [[rare]].<ref name="pmid1846439">{{cite journal| author=Mittendorf R, Williams MA| title=Rho(D) immunoglobulin (RhoGAM): how it came into being. | journal=Obstet Gynecol | year= 1991 | volume= 77 | issue= 2 | pages= 301-3 | pmid=1846439 | doi=10.1097/00006250-199102000-00029 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1846439  }} </ref>
*The idea behind the [[development]] of [[phototherapy]] was first discovered at Rochford General [[Hospital]], Essex in the 1950s. [[Babies]] carried out to the warm sunshine with the aim of having a timeout from the [[incubator]] literally became ''less yellow'' than before. Subsequently, [[lab]] [[results]] further [[Confirmatory factor analysis|confirmed]] this [[Discovery Investigations|discovery]]. <ref name="pmid23650299">{{cite journal| author=Weiss EM, Zimmerman SS| title=A tale of two hospitals: the evolution of phototherapy treatment for neonatal jaundice. | journal=Pediatrics | year= 2013 | volume= 131 | issue= 6 | pages= 1032-4 | pmid=23650299 | doi=10.1542/peds.2012-3651 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23650299  }} </ref>


==Classification==
==Classification==
*Jaundice may be classified into two broad categories based on time of onset and cause of jaundice.
 
**'''Physiologic jaundice''':
*[[Jaundice]] may be [[Classification|classified]] into two broad [[categories]] based on its time of onset and [[Causes|cause]] as shown in the table below:
***Seen after the first 24 hours of life.
 
***Serum bilirubin levels never rise >5mg/dl daily and maximum concentration is about 12mg/dl and 14mg/dl in full terms and preterms respectively.
{| class="wikitable"
***Reaches the highest levels in the 4th-5th days and resolves within 2 weeks in both full-term and preterm infants.  
|+Classification of Jaundice
***Infants usually appears well.
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Type of Jaundice
**'''Pathological jaundice''':
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Details
***Appears anytime from the first few hours of life.
|-
***Serum bilirubin levels rise at a rate of >5mg/dl per day or 0.5mg/dl per hour and maximum concentration is usually >12mg/dl and >14mg/dl in full terms and preterms respectively.
| align="center" style="background:#DCDCDC;" + |'''[[Physiologic]] [[jaundice]]'''
***Infants appear ill and pale with abnormal discoloration of urine and stool.<ref name="pmid30422525">{{cite journal| author=| title=StatPearls | journal= | year= 2020 | volume=  | issue=  | pages=  | pmid=30422525 | doi= | pmc= | url= }} </ref>
|
*Seen after the first 24 hours of [[life]].
*[[Serum bilirubin]] never exceeds >5mg/dl daily and the maximum [[concentration]] is about 12mg/dl and 14mg/dl in full terms and [[preterms]] respectively.
*The highest levels are attained in the first 4-5 days of [[life]] and resolve within 2 weeks in both full-term and [[preterm]] [[infants]].
*[[Infants]] usually [[Appearance|appear]] well.
|-
| align="center" style="background:#DCDCDC;" + |'''[[Pathological]] [[jaundice]]'''<ref name="pmid30422525">{{cite journal| author=| title=StatPearls | journal= | year= 2020 | volume=  | issue=  | pages=  | pmid=30422525 | doi= | pmc= | url= }} </ref>
|
*Seen anytime from the first few hours of [[life]].
*[[Serum bilirubin]] increases at a [[rate]] of >5mg/dl per day or 0.5mg/dl per hour and maximum [[concentration]] is usually >12mg/dl and >14mg/dl in full terms and [[preterms]] respectively.
*[[Infants]] appear [[ill]] and [[pale]] with [[abnormal]] discoloration of [[urine]] and [[stool]].
|}


==Pathophysiology==
==Pathophysiology==


*Jaundice is caused by hyperbilirubinemia which is high concentrations of bilirubin in the bloodstream.
*[[Jaundice]] is caused by high [[concentrations]] of [[bilirubin]] in the [[bloodstream]], a [[condition]] known as [[hyperbilirubinemia]].
*Hyperbilirubinemia can result from abnormalities in the metabolism of bilirubin which could occur at any stage from its production, hepatic metabolism, and its post hepatic transport.
*[[Hyperbilirubinemia]] can [[result]] from [[abnormalities]] in the [[metabolism]] of [[bilirubin]] which could occur at any stage from its [[production]], which is as a [[result]] of the excessive [[breakdown]] of [[red blood cells]], [[Defect|defects]] in its [[hepatic]] [[metabolism]], and its post [[hepatic]] [[Transporter|transport]].
*Hemoglobin released from the breakdown of old or defective red blood cells is composed of heme and globin. Globin is broken down into its component amino acids and recycled while heme is split into iron and biliverdin by the enzyme, heme oxygenase in the reticuloendothelial system. Iron is transferred to ferritin and used again to make hemoglobin while biliverdin is converted to bilirubin by biliverdin reductase. <ref name="pmid30422525">{{cite journal| author=| title=StatPearls | journal= | year= 2020 | volume=  | issue=  | pages=  | pmid=30422525 | doi= | pmc= | url= }} </ref>
*[[Hemoglobin]] from the [[breakdown]] of effete [[red blood cells]] is composed of [[heme]] and [[globin]]. [[Globin]] is further dismantled into its component [[amino acids]] and [[recycled]] while [[heme]] is split into [[iron]] and [[biliverdin]] by the [[enzyme]], [[heme oxygenase]] in the [[reticuloendothelial]] [[system]]. [[Iron]] is transferred to [[ferritin]] and used again to make [[hemoglobin]] while [[biliverdin]] is converted to [[bilirubin]] by [[biliverdin reductase]]. <ref name="pmid30422525">{{cite journal| author=| title=StatPearls | journal= | year= 2020 | volume=  | issue=  | pages=  | pmid=30422525 | doi= | pmc= | url= }} </ref>
*Bilirubin, which is water-insoluble becomes coupled to albumin and transported into hepatic cells for conjugation.  
*[[Water]]-insoluble [[bilirubin]] becomes coupled to [[albumin]] and transported into [[hepatic]] [[cells]] for [[conjugation]].
*This albumin-bilirubin compound is broken down and the unconjugated bilirubin enters the cytosol of hepatocytes to be conjugated to glucuronic acid in the endoplasmic reticulum by the enzyme, Uridine diphosphate glucuronosyltransferase (UDPGT). <ref name="pmid31334972">{{cite journal| author=| title=StatPearls | journal= | year= 2020 | volume=  | issue=  | pages=  | pmid=31334972 | doi= | pmc= | url= }} </ref>
*This [[albumin]]-[[bilirubin]] compound is broken down and the [[unconjugated bilirubin]] enters the [[cytosol]] of [[hepatocytes]] to be [[Conjugated bilirubin|conjugated]] to [[glucuronic acid]] in the [[endoplasmic reticulum]] by the [[enzyme]], [[Uridine diphosphate glucuronyltransferase|uridine diphosphate glucuronyltransferase (UDPGT)]].<ref name="pmid31334972">{{cite journal| author=| title=StatPearls | journal= | year= 2020 | volume=  | issue=  | pages=  | pmid=31334972 | doi= | pmc= | url= }} </ref>
*Conjugated bilirubin is secreted into bile and then into the small intestine after being stored in the gall bladder. It eventually gets to the colon where it is acted upon by bacterial flora and deconjugated to urobilinogen. Most of these are excreted into feces as the brown pigment, stercobilin, and the rest is reabsorbed into the blood, converted to yellow urobilin which is eventually excreted into the urine. <ref>https://www.rahulgladwin.com/noteblog/gastroenterology/jaundice.php</ref>
*This [[Conjugated bilirubin|conjugated]] form of [[bilirubin]] is [[Secretion|secreted]] into [[bile]] and then into the [[small intestine]] after being stored in the [[gall bladder]]. It subsequently reaches the [[colon]] where it is acted upon by [[bacterial]] [[flora]] and deconjugated to [[urobilinogen]]. Most are [[excreted]] into [[feces]] as the [[brown]] [[pigment]], [[stercobilin]], and the rest is [[reabsorbed]] into the [[blood]], converted to yellow [[urobilin]] which is eventually excreted into the [[urine]].
*Conjugated or unconjugated hyperbilirubinemia gives a clue as to the defective mechanism/point in the system responsible for the metabolism of bilirubin.
*[[Hyperbilirubinemia]] whether [[Conjugated bilirubin|conjugated]] or [[Unconjugated bilirubin|unconjugated]] gives a clue as to the [[Defect|defective]] point in the [[metabolism]] of [[bilirubin]].


==Causes==
==Causes==
Disease name] may be caused by [cause1], [cause2], or [cause3].


OR
*[[Causes]] of [[jaundice]] in [[children]] can be [[Classification|classified]] as follows:
{{familytree/start}}
{{familytree| | | | | | | A01 | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |A01=[[Causes]] of [[jaundice]] in [[children]]}}
{{familytree| | | | |,|-|-|^|-|-|.| | | | | | | | | | | | | | | | | | | | | | | | | | | |}}
{{familytree| | | | B01 | | | | B02 | | | | | | | | | | | | | | | | | | | | | | | | | | |B01=[[Physiologic]]|B02=[[Pathologic]]}}
{{familytree| | | | | | | | | | |!| | | | | | | | | | | | | | | | | | | | | | | | | | | |}}
{{familytree| | | | | | | |,|-|-|^|-|-|.| | | | | | | | | | | | | | | | | | | | | | | | |}}
{{familytree| | | | | | | C01 | | | | C02 | | | | | | | | | | | | | | | | | | | | | | | |C01=Unconjugated [[hyperbilirubinemia]]|C02=Conjugated [[hyperbilirubinemia]]}}
{{familytree| | | | | | | |!| | | | | |!| | | | | | | | | | | | | | | | | | | | | | | | |}}
{{familytree| | | | | | | |!| | | | | |!| | | | | | | | | | | | | | | | | | | | | | | | |}}
{{familytree| | | | |,|-|-|^|-|-|.| | |!| | | | | | | | | | | | | | | | | | | | | | | | |}}
{{familytree| | | | D01 | | | | D02 | |!| | | | | | | | | | | | | | | | | | | | | | | | |D01=[[Hemolytic]]|D02=Non-[[hemolytic]]}}
{{familytree| | | | |!| | | | | |!| | |!| | | | | | | | | | | | | | | | | | | | | | | | |}}
{{familytree| | | | |!| | | | | |!| | |!| | | | | | | | | | | | | | | | | | | | | | | | |}}
{{familytree| | | | E01 | | | | E02 | |!| | | | | | | | | | | | | | | | | | | | | | | | |E01=•Rh incompatibility<br>•[[ABO]] incompatibility<br>•[[Hemoglobinopathies]] ([[Thalassemia]])<br>•Hematomas<br>•[[Polycythemia]]<br>•[[Sepsis]]|E02=•[[Crigler-Najjar syndrome]] I and II<br>•[[Gilbert syndrome]]<br>•[[Breast milk]] [[jaundice]]}}
{{familytree| | | | | | | | | | | | | |!| | | | | | | | | | | | | | | | | | | | | | | | |}}
{{familytree| |,|-|-|-|v|-|-|-|v|-|-|-|+|-|-|-|v|-|-|-|.| | | | | | | | | | | | | | | | |}}
{{familytree| |!| | | |!| | | |!| | | |!| | | |!| | | |!| | | | | | | | | | | | | | | | |}}
{{familytree| F01 | | F02 | | F03 | | F04 | | F05 | | F06 | | | | | | | | | | | | | | | |F01=[[Infectious]]|F02=Obstructive|F03=[[Drugs]]|F04=[[Genetic]]/[[Metabolic]]|F05=Storage disorders|F06=Endocirnopathies}}
{{familytree| |!| | | |!| | | |!| | | |!| | | |!| | | |!| | | | | | | | | | | | | | | | |}}
{{familytree| G01 | | G02 | | G03 | | G04 | | G05 | | G06 | | | | | | | | | | | | | | | | | | | | | |G01=•[[Viral]]<br>•[[Bacterial]]<br>•[[Parasitic]]|G02=•[[Biliary atresia]]<br>•[[Choledochal cyst]]<br>•Inspissated [[bile]] syndrome<br>•[[Neonatal]] [[sclerosing cholangitis]]<br>•[[Congenital]] [[hepatic fibrosis]]<br>•Intrinsic/extrinsic [[mass]]|G03=•[[Ceftriaxone]]<br>•[[Isoniazid]]<br>•[[Erythromycin]]<br>•[[Rifampin]]<br>•[[Sulfa]] [[drugs]]<br>•[[Parenteral nutrition]]<br>•[[Methotrexate]]|G04=•[[Alpha 1 antitrypsin]] [[deficiency]]<br>•[[Alagille syndrome]]<br>•[[Cystic fibrosis]]<br>•[[Tyrosinemia]]<br>•[[Galactosemia]]<br>•[[Rotor syndrome]]<br>•[[Trisomy 18]] and [[Trisomy 21]]|G05=•[[Gaucher's Disease]]<br>•Niemann-pick Disease<br>•[[Glycogen storage diseases]]<br>•[[Mucolipidoses]]|G06=•[[Hypopituitarism]]<br>•[[Hypothyroidism]]<br>•McCune Albright syndrome}}
{{familytree| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |}}
{{familytree/end}}


Common causes of [disease] include [cause1], [cause2], and [cause3].
==Differentiating jaundice in children from other diseases==


OR
*Alternative [[Diagnosis|diagnoses]] for [[jaundice]] are limited however, some [[Skin discoloration|skin discolorations]] in [[healthy]] individuals can resemble [[jaundice]] in certain circumstances.
*Use of the [[antimalarial]] and [[antihelminthic|anti-helminthic]] [[drug]], [[Quinacrine]] can cause [[Yellow discolouration|yellowish discoloration]] of the [[skin]] of individuals who take it.
*Excessive consumption of [[fruits]] and [[vegetables]] high in [[carotenes]] such as carrots and sweet potatoes can cause a [[skin discoloration]] termed as Carotenoderma.
*The above differentials spare the [[mucous membranes]] and [[sclera]].<ref name="pmid30422525">{{cite journal| author=| title=StatPearls | journal= | year= 2020 | volume=  | issue=  | pages=  | pmid=30422525 | doi= | pmc= | url= }} </ref><ref name="pmid31334972">{{cite journal| author=| title=StatPearls | journal= | year= 2020 | volume=  | issue=  | pages=  | pmid=31334972 | doi= | pmc= | url= }} </ref>


The most common cause of [disease name] is [cause 1]. Less common causes of [disease name] include [cause 2], [cause 3], and [cause 4].
==Epidemiology and Demographics==


OR
*The [[prevalence]] of [[jaundice]] varies among [[patient]] [[populations]].
 
*In [[infants]] born at [[term]], 60% will develop [[jaundice]] in their first week of life which rises to 80% in preterms.<ref name="pmid30422525">{{cite journal| author=| title=StatPearls | journal= | year= 2020 | volume=  | issue=  | pages=  | pmid=30422525 | doi= | pmc= | url= }} </ref>
The cause of [disease name] has not been identified. To review risk factors for the development of [disease name], click [[Pericarditis causes#Overview|here]].
*5-10% of [[neonates]] will require being admitted for the [[treatment]] of pathological [[jaundice]].<ref name="pmid18334797">{{cite journal| author=Mishra S, Agarwal R, Deorari AK, Paul VK| title=Jaundice in the newborns. | journal=Indian J Pediatr | year= 2008 | volume= 75 | issue= 2 | pages= 157-63 | pmid=18334797 | doi=10.1007/s12098-008-0024-7 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18334797  }} </ref>
==Differentiating [disease name] from other Diseases==
*Causes of [[jaundice]] also vary with [[age]] groups. In [[newborns]], immature [[hepatic]] [[conjugation]], [[hemolysis]], and certain [[congenital disorders]] are the top [[causes]], whereas [[Hepatitis A]] [[infection]] is a [[Causes|cause]] seen more in older [[children]].
 
*Death [[rate]] is 0.28 per 1 million [[Live birth|live births]].<ref name="pmid31334972">{{cite journal| author=| title=StatPearls | journal= | year= 2020 | volume=  | issue=  | pages=  | pmid=31334972 | doi= | pmc= | url= }} </ref>
For further information about the differential diagnosis, click [[Disease_Name differential diagnosis|here]].
 
==Epidemiology and Demographics==
*The prevalence of jaundice varies among patient populations.
*In infants born at term, 60% will develop jaundice in their first-week life. This rises to 80% in preterms. <ref name="pmid30422525">{{cite journal| author=| title=StatPearls | journal= | year= 2020 | volume=  | issue=  | pages=  | pmid=30422525 | doi= | pmc= | url= }} </ref>
*5-10% of neonates will require being admitted for the treatment of pathological jaundice. <ref name="pmid18334797">{{cite journal| author=Mishra S, Agarwal R, Deorari AK, Paul VK| title=Jaundice in the newborns. | journal=Indian J Pediatr | year= 2008 | volume= 75 | issue= 2 | pages= 157-63 | pmid=18334797 | doi=10.1007/s12098-008-0024-7 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18334797  }} </ref>  
*Causes of jaundice also vary with age groups. In newborns, immature hepatic conjugation, hemolysis, and certain congenital disorders are top causes while Hepatitis A infection is a cause seen more in older children.
*Death rate is 0.28 per 1 million live births. <ref name="pmid31334972">{{cite journal| author=| title=StatPearls | journal= | year= 2020 | volume=  | issue=  | pages=  | pmid=31334972 | doi= | pmc= | url= }} </ref>
   
   
===Age===
===Age===


*Patients of all age groups may develop Jaundice.
*[[Patients]] of all [[age]] groups may [[Development|develop]] [[jaundice]].
*It is more commonly observed in newborns and the elderly populations. <ref name="pmid31334972">{{cite journal| author=| title=StatPearls | journal= | year= 2020 | volume=  | issue=  | pages=  | pmid=31334972 | doi= | pmc= | url= }} </ref>
*It is more commonly observed in [[newborns]] and the [[elderly]] [[population]].<ref name="pmid31334972">{{cite journal| author=| title=StatPearls | journal= | year= 2020 | volume=  | issue=  | pages=  | pmid=31334972 | doi= | pmc= | url= }} </ref>
   
   
===Gender===
===Gender===


*Gender predilection can be observed in the etiology of jaundice.  
*[[Gender]] preference can be observed in the [[etiology]] of [[jaundice]].
*An example is the documented male preponderance of Glucose-6-Phosphate dehydrogenase (G6PD) deficiency with an incidence of 4.5% males to 0.5% in females. <ref name="pmid29807950">{{cite journal| author=Chee YY, Chung PH, Wong RM, Wong KK| title=Jaundice in infants and children: causes, diagnosis, and management. | journal=Hong Kong Med J | year= 2018 | volume= 24 | issue= 3 | pages= 285-292 | pmid=29807950 | doi=10.12809/hkmj187245 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29807950  }} </ref>
*An example is the documented [[male]] preponderance of [[Glucose-6-phosphate dehydrogenase deficiency|glucose-6-Phosphate dehydrogenase (G6PD) deficiency]] with an [[incidence]] of 4.5% [[males]] to 0.5% in [[females]].<ref name="pmid29807950">{{cite journal| author=Chee YY, Chung PH, Wong RM, Wong KK| title=Jaundice in infants and children: causes, diagnosis, and management. | journal=Hong Kong Med J | year= 2018 | volume= 24 | issue= 3 | pages= 285-292 | pmid=29807950 | doi=10.12809/hkmj187245 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29807950  }} </ref>


===Race===
===Race===


*Racial predilection for Jaundice is observed in a cause of unconjugated hyperbilirubinemia, Gilbert syndrome.  
*[[Racial]] predisposition for [[jaundice]] is observed in a [[Causes|cause]] of [[Unconjugated bilirubin|unconjugated]] [[hyperbilirubinemia]] such as [[Gilbert syndrome]].
*This is caused by a genetic mutation in the gene responsible for the production of the enzyme, UDPGT. It is a diagnosis of exclusion and symptoms are triggered by stressful situations like dehydration, illness.  
*A [[genetic]] [[mutation]] in the [[gene]] responsible for the [[Product (biology)|production]] of the [[enzyme]], UDPGT is its [[Causes|cause]]. [[Diagnosis]] is made only when alternative explanations have been ruled out. [[Symptoms]] are triggered by stressful situations such as [[dehydration]], and [[illness]].
*It has a prevalence of 5-10% in Caucasian and Asian populations. <ref name="pmid29807950">{{cite journal| author=Chee YY, Chung PH, Wong RM, Wong KK| title=Jaundice in infants and children: causes, diagnosis, and management. | journal=Hong Kong Med J | year= 2018 | volume= 24 | issue= 3 | pages= 285-292 | pmid=29807950 | doi=10.12809/hkmj187245 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29807950  }} </ref>
*It has a [[prevalence]] of 5-10% in Caucasian and Asian [[populations]].<ref name="pmid29807950">{{cite journal| author=Chee YY, Chung PH, Wong RM, Wong KK| title=Jaundice in infants and children: causes, diagnosis, and management. | journal=Hong Kong Med J | year= 2018 | volume= 24 | issue= 3 | pages= 285-292 | pmid=29807950 | doi=10.12809/hkmj187245 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29807950  }} </ref>


==Risk Factors==
==Risk Factors==


*Common risk factors in the development of Jaundice in children are:  
*Common [[risk factors]] for the [[development]] of [[jaundice]] in [[children]] are:  
**Family history of jaundice
**[[Family history]] of [[jaundice]]
**Family history of a child born with jaundice
**[[Family history]] of a [[child]] born with [[jaundice]]
**Hyperthyroidism in mother
**[[Hyperthyroidism]] in the [[mother]]
**Medication use by mother
**[[Medication]] used by the [[mother]]
**Gestational Diabetes Mellitus (GDM)
**[[Gestational diabetes|Gestational Diabetes Mellitus]] ([[GDM]])
**Race (Asian)
**[[Race]] (Asian)
**Age >25 years
**[[Age]] >25 [[Year|years]]
**ABO incompatibility
**[[ABO]] incompatibility
**Rh incompatibility
**[[Rh disease|Rh]] incompatibility
**Exclusive breastfeeding
**Exclusive [[breastfeeding]]
**Inability to breastfeed adequately
**Inability to [[Breastfeeding|breastfeed]] adequately
**Primiparity
**Primiparity
**Oxytocin use during labor
**[[Oxytocin]] use during [[labor]]
**Prematurity
**[[Prematurity]]
**Weight loss(child)
**[[Weight loss]] ([[child]])
**Male gender
**[[Male]] gender
**Polycythemia
**[[Polycythemia]]
**Cephalhematoma, hematoma in spleen or liver, resulting in excessive hemolysis with red blood cell breakdown
**[[Hematoma]] in [[spleen]] or [[liver]], [[cephalhematoma]], causing excessive [[hemolysis]] with [[red blood cell]] breakdown
**Trisomy 21
**[[Trisomy 21]]
**G6PD deficiency
**[[G6PD]] [[deficiency]]
**Congenital infection (TORCHES) <ref name="pmid30159062">{{cite journal| author=Mojtahedi SY, Izadi A, Seirafi G, Khedmat L, Tavakolizadeh R| title=Risk Factors Associated with Neonatal Jaundice: A Cross-Sectional Study from Iran. | journal=Open Access Maced J Med Sci | year= 2018 | volume= 6 | issue= 8 | pages= 1387-1393 | pmid=30159062 | doi=10.3889/oamjms.2018.319 | pmc=6108787 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30159062  }} </ref> <ref name="pmid30422525">{{cite journal| author=| title=StatPearls | journal= | year= 2020 | volume=  | issue=  | pages=  | pmid=30422525 | doi= | pmc= | url= }} </ref>
**[[Congenital]] [[infection]] ([[TORCHES]])<ref name="pmid30159062">{{cite journal| author=Mojtahedi SY, Izadi A, Seirafi G, Khedmat L, Tavakolizadeh R| title=Risk Factors Associated with Neonatal Jaundice: A Cross-Sectional Study from Iran. | journal=Open Access Maced J Med Sci | year= 2018 | volume= 6 | issue= 8 | pages= 1387-1393 | pmid=30159062 | doi=10.3889/oamjms.2018.319 | pmc=6108787 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30159062  }} </ref><ref name="pmid30422525">{{cite journal| author=| title=StatPearls | journal= | year= 2020 | volume=  | issue=  | pages=  | pmid=30422525 | doi= | pmc= | url= }} </ref>


==Natural History, Complications and Prognosis==
==Natural History, Complications and Prognosis==


*It is essential for every clinician to note that jaundice is not always a benign condition therefore, extensive investigation of a child with jaundice is necessary to prevent severe complications.
*It is essential for every [[clinician]] to note that [[jaundice]] is not always a [[benign]] [[condition]] therefore, extensive [[Investigational product|investigation]] of a [[child]] with [[jaundice]] is necessary to [[Prevention (medical)|prevent]] severe [[complications]].
*Bilirubin-induced neurological dysfunction (BIND) seen in the setting of extremely high unconjugated bilirubin levels is a rare complication.  
*In the setting of very high [[unconjugated bilirubin]] levels, a [[rare]] [[complication]] known as [[bilirubin]]-induced [[Neurological disorder|neurological dysfunction]] (BIND) is observed.
*It is a condition in which high levels of unconjugated bilirubin crosses the immature blood-brain-barrier of neonates and binds to glial tissue and brainstem nuclei.  
*Elevated levels of [[unconjugated bilirubin]] crosses the immature [[blood-brain-barrier]] of [[neonates]] binding to [[glial]] [[tissue]] and [[brainstem]] [[nuclei]].
*Lack of colonic bacteria in neonates also predisposes them to this outcome due to increased enterohepatic reabsorption of deconjugated bilirubin.  
*Lack of [[colonic]] [[bacteria]] in [[neonates]] also predisposes them to this [[outcome]] due to increased [[enterohepatic]] [[reabsorption]] of [[Unconjugated bilirubin|deconjugated bilirubin]].
*Bilirubin encephalopathy, a catastrophic neurologic outcome known as Kernicterus or death are likely complications if treatment is either delayed or not promptly instituted.
*[[Bilirubin]] [[encephalopathy]], a catastrophic [[neurologic]] [[outcome]] known as [[kernicterus]] or death are likely [[complications]] if [[treatment]] is either delayed or not promptly instituted.
*Early symptoms of kernicterus are:
*Early [[symptoms]] of [[kernicterus]] are:
**Poor feeding
**Poor [[feeding]]
**Irritability
**[[Irritability]]
**High-pitched cry
**High-[[Pitch|pitched]] [[cry]]
**Apnea
**[[Apnea]]
**Floppy muscles
**[[Floppy muscles]]
*As the illness progresses, more severe symptoms are:
*As the [[illness]] progresses, more severe [[symptoms]] are:
**Seizures
**[[Seizures]]
**Muscular spasms
**[[Muscular]] [[spasms]]
**Cerebral palsy
**[[Cerebral palsy]]
**Learning problems
**[[Learning]] [[Problem Solved|problems]]
**Loss of hearing <ref>https://www.nhs.uk/conditions/jaundice-newborn/complications/</ref>
**Loss of [[hearing]]
*[[Complications]] from the [[causes]] of [[Conjugated bilirubin|conjugated]] [[hyperbilirubinemia]] include:
**[[Liver failure]]
**[[Malabsorption]] of [[fat]] and [[fat-soluble]] [[vitamins]] from [[cholestasis]]
**[[Portal hypertension]]
**[[Cirrhosis]]
**Progression to [[hepatocellular carcinoma]] ([[Hepatocellular carcinoma|HCC]])
**[[Cholangiocarcinoma]] in [[patients]] with [[choledochal cyst]]
**Post Kasai [[procedure]] [[ascending cholangitis]]
*[[Prognosis]] is promising with prompt [[diagnosis]] and [[treatment]]. However, [[Conjugated bilirubin|conjugated]] [[hyperbilirubinemia]] from the [[Obstruction|obstructions]] of [[hepatic]] and [[biliary]] tree have poorer [[Outcome|outcomes]].<ref name="pmid31334972">{{cite journal| author=| title=StatPearls | journal= | year= 2020 | volume=  | issue=  | pages=  | pmid=31334972 | doi= | pmc= | url= }} </ref>


==Diagnosis==
==Diagnosis==
===Diagnostic Criteria===
*The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met:
:*[criterion 1]
:*[criterion 2]
:*[criterion 3]
:*[criterion 4]
===Symptoms===
===Symptoms===


*[Disease name] is usually asymptomatic.
*[[Symptoms]] of [[jaundice]] in [[children]] may include the following:
*Symptoms of [disease name] may include the following:
**[[Skin]], [[sclera]] and [[mucous membrane]] discoloration
**Time of onset and duration
**Progression (involvement up to which [[body]] part)
**Poor [[feeding]]
**[[Irritability]]
**[[Fever]]
**[[Pruritus]]
**[[Rash]]
**[[Pain]] in [[joints]]
**Recent travel history
**[[Diarrhea]]
**[[Urine]] and [[stool]] [[color]] change
**[[Anorexia]]
**[[Weight loss]]
**[[Body]] [[pains]] such as [[abdominal]] [[discomfort]]/[[pains]]


:*[symptom 1]
:*[symptom 2]
:*[symptom 3]
:*[symptom 4]
:*[symptom 5]
:*[symptom 6]
===Physical Examination===
===Physical Examination===


*Patients with [disease name] usually appear [general appearance].
*[[Patients]] appear yellow on the [[skin]], [[mucous membranes]] and/or [[sclera]]. A useful technique in assessing the severity of [[jaundice]] is by using the principle of [[skin discoloration]] progressing in a cephalo-caudal [[direction]] in [[newborns]].
*Physical examination may be remarkable for:
*If [[discoloration]] has progressed to the [[thigh]] level, [[samples]] for urgent [[serum bilirubin]] should be taken.
 
*This method is not necessary for [[infants]] who are already receiving [[phototherapy]] and those with darker colored [[skin]].
:*[finding 1]
*Other findings on [[examination]] are:
:*[finding 2]
**[[Irritable]] [[infant]]
:*[finding 3]
**[[Fever]]
:*[finding 4]
**[[Rash]]
:*[finding 5]
**[[Examine]] [[urine]] and [[stool]]
:*[finding 6]
**Small or large for [[age]]
**[[Lymph nodes enlarged|Lymph node enlargement]]
**[[Muscle]] [[spasms]]
**Inconsolable [[cry]]
**[[Cardiac murmurs]]
**[[Hepatomegaly]]
**[[Splenomegaly]]
**[[Ascites]]


===Laboratory Findings===
===Laboratory Findings===


*There are no specific laboratory findings associated with [disease name].
*Measuring the level of [[bilirubin]].
 
**[[Serum bilirubin]] from a [[blood]] [[sample]]. The total and [[Conjugated bilirubin|conjugated portions]] are measured first and the [[Unconjugated bilirubin|unconjugated fraction]] is measured by subtracting the [[Conjugated bilirubin|conjugated fraction]] from the total.
*A  [positive/negative] [test name] is diagnostic of [disease name].
**Knowing the type of [[hyperbilirubinemia]] will guide further workup in identifying the [[Causes|cause]] of [[jaundice]]. [[Conjugated bilirubin|Conjugated]] or mixed [[hyperbilirubinemia]] gives a speculation of [[hepatic]] or post-[[hepatic]] [[etiology]].
*An [elevated/reduced] concentration of [serum/blood/urinary/CSF/other] [lab test] is diagnostic of [disease name].
**Transcutaneous bilirubinometer. The [[accuracy]] of this can be altered by [[skin]] thickness and [[color]].
*Other laboratory findings consistent with the diagnosis of [disease name] include [abnormal test 1], [abnormal test 2], and [abnormal test 3].
**Bilimeter
*[[Complete blood count]] with differentials and [[Smear test|smear]]
*[[Blood]] and [[Rh (D) disease|Rh]] group
*[[G6PD]] levels
*[[Newborn screening]] for:
**[[Cystic fibrosis]]
**[[Tyrosinemia]]
**[[Galactosemia]]
**[[Hypothyroidism]]
*To assess [[liver]] [[synthetic]] [[Function (biology)|function]]:
**[[Prothrombin time]] ([[PT]])
**[[Serum albumin]]
*[[Liver function tests]]
**[[AST]]
**[[ALT]]
**[[ALP]]
**[[GGT]]
*[[Alpha 1 antitrypsin]] levels and [[phenotype]]
*[[Viral]] [[serologies]]
**[[Hepatitis A|Hepatitis A Virus]] ([[HAV]])
**[[HBV]]
**[[HCV]]
**[[HDV]]
**[[HEV]]
**[[HIV]]
**[[CMV]]
**[[EBV]]
**[[Parvovirus B19]]
*[[Serum]] [[ammonia]]
*[[Blood cultures]]
*[[Urinalysis]]
*[[Urine]] [[microscopy]], [[culture]], and [[sensitivity]]
*[[Stool]] [[microscopy]], [[culture]], and [[sensitivity]]
*[[TORCH]] [[screening]]
*[[Serum]] [[ferritin]]
*[[Serum]] [[ceruloplasmin]]
*[[Autoimmune]] [[antibodies]]


===Electrocardiogram===
===Electrocardiogram===
There are no ECG findings associated with [disease name].
OR


An ECG may be helpful in the diagnosis of [disease name]. Findings on an ECG suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
*There are no [[ECG]] findings [[Association (statistics)|associated]] with [[jaundice]] in [[children]].
*It may be used to monitor [[cardiac]] [[Rhythm|rhythms]] during [[treatment]].


===X-ray===
===X-ray===
There are no x-ray findings associated with [disease name].


OR
*A [[chest radiograph]] can reveal [[cardiomegaly]] in individuals with [[Alagille syndrome]].


An x-ray may be helpful in the diagnosis of [disease name]. Findings on an x-ray suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
===Echocardiography and Ultrasound===


OR
*[[Echocardiography]] can detect [[cardiac]] [[abnormalities]] in [[patients]] with [[Alagille syndrome]] and [[biliary atresia]].
 
*[[Ultrasonography]] of the [[abdomen]] is used to [[screen]] for [[biliary atresia]], [[choledochal cysts]] or [[cholestatic]] workup in the setting of [[Conjugated bilirubin|conjugated]] [[hyperbilirubinemia]].<ref name="pmid29807950">{{cite journal| author=Chee YY, Chung PH, Wong RM, Wong KK| title=Jaundice in infants and children: causes, diagnosis, and management. | journal=Hong Kong Med J | year= 2018 | volume= 24 | issue= 3 | pages= 285-292 | pmid=29807950 | doi=10.12809/hkmj187245 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29807950  }} </ref>
There are no x-ray findings associated with [disease name]. However, an x-ray may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].
 
===Echocardiography or Ultrasound===
There are no echocardiography/ultrasound findings associated with [disease name].
 
OR
 
Echocardiography/ultrasound  may be helpful in the diagnosis of [disease name]. Findings on an echocardiography/ultrasound suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
 
OR
 
There are no echocardiography/ultrasound  findings associated with [disease name]. However, an echocardiography/ultrasound  may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].


===CT scan===
===CT scan===
There are no CT scan findings associated with [disease name].
OR
[Location] CT scan may be helpful in the diagnosis of [disease name]. Findings on CT scan suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].


OR
*A [[CT scan]] of the [[abdomen]] is used to [[screen]] for [[biliary atresia]], [[choledochal cysts]], or [[cholestatic]] workup in the setting of [[Conjugated bilirubin|conjugated]] [[hyperbilirubinemia]].
 
There are no CT scan findings associated with [disease name]. However, a CT scan may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].


===MRI===
===MRI===
There are no MRI findings associated with [disease name].


OR
*A [[MRI]] is used to [[screen]] for [[biliary atresia]], [[choledochal cysts]], or [[cholestatic]] workup in the setting of [[Conjugated bilirubin|conjugated]] [[hyperbilirubinemia]].
 
[Location] MRI may be helpful in the diagnosis of [disease name]. Findings on MRI suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
 
OR
 
There are no MRI findings associated with [disease name]. However, a MRI may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].


===Other Imaging Findings===
===Other Imaging Findings===
There are no other imaging findings associated with [disease name].
OR


[Imaging modality] may be helpful in the diagnosis of [disease name]. Findings on an [imaging modality] suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
*Other [[Imaging studies|imaging modalities]] used for [[screening]] for [[cholestatic]] workup include the following:
**[[Magnetic resonance cholangiopancreatography]] ([[MRCP]])
**[[Endoscopic retrograde cholangiopancreatography]] ([[ERCP]])
**Hepatobiliary scintigraphy with technetium-labeled iminodiacetic acid analog ([[HIDA scan|HIDA]])
**[[Percutaneous transhepatic cholangiography]] ([[PTC]])


===Other Diagnostic Studies===
===Other Diagnostic Studies===


*[Disease name] may also be diagnosed using [diagnostic study name].
*[[Diagnostic]] [[laparoscopy]] with/without [[treatment]]
*Findings on [diagnostic study name] include [finding 1], [finding 2], and [finding 3].
*[[Liver biopsy]]


==Treatment==
==Treatment==
===Medical Therapy===
===Medical Therapy===


*There is no treatment for [disease name]; the mainstay of therapy is supportive care.
*[[Treatment]] of [[jaundice]] is usually tailored towards the underlying [[etiology]] whether it a [[hematologic]] [[disease]] or a [[Hepatobiliary disease|hepatobiliary]] [[pathology]].<ref name="pmid31334972">{{cite journal| author=| title=StatPearls | journal= | year= 2020 | volume=  | issue=  | pages=  | pmid=31334972 | doi= | pmc= | url= }} </ref>
*[[Treatment]] options include the following:
*The mainstay of therapy for [disease name] is [medical therapy 1] and [medical therapy 2].
**[[Phototherapy]]: Usually first line in [[neonates]] with severe [[hyperbilirubinemia]] to prevent [[neurologic]] [[sequelae]].
*[Medical therapy 1] acts by [mechanism of action 1].
**[[Intravenous]] [[immunoglobulin]] ([[IVIG]]): Helpful in [[hemolytic]] [[diseases]] and can be used in place of [[phototherapy]] and/or [[exchange transfusion]].
*Response to [medical therapy 1] can be monitored with [test/physical finding/imaging] every [frequency/duration].
**[[Exchange transfusion]]: When the above options become inadequate to reduce the levels of rising [[bilirubin]] or at the slightest clue of [[bilirubin]] [[encephalopathy]], an [[exchange transfusion]] is done usually in the [[NICU]]/[[PICU]] and should be closely followed up for [[complications]] such as:<ref name="pmid30422525">{{cite journal| author=| title=StatPearls | journal= | year= 2020 | volume=  | issue=  | pages=  | pmid=30422525 | doi= | pmc= | url= }} </ref>
***[[Cardiac arrhythmias]]
***[[Sepsis]]
***[[Hyperkalemia]]
***[[Hypocalcemia]]
***[[Necrotising enterocolitis]]
***[[Exchange transfusion]] also removes [[hemolytic]] [[antibodies]] from Rh [[isoimmunization]] and [[ABO]] incompatibility.
**[[Pharmacologic]] remedies such as:
***[[Phenobarbitone]]
***[[Metalloporphyrins]]
*[[Patients]] with [[pruritus]] especially older kids can be treated with warm baths or given [[antihistamines]]. [[Cholestyramine]] can be used in severe cases of [[pruritus]].<ref name="pmid31334972">{{cite journal| author=| title=StatPearls | journal= | year= 2020 | volume=  | issue=  | pages=  | pmid=31334972 | doi= | pmc= | url= }} </ref>
*Appropriate [[antiviral]], [[antibacterial]], and [[antiparasitic]] [[therapy]] for [[jaundice]] of [[viral]], [[bacterial]] and [[parasitic]] [[etiology]] respectively.
 
===Surgery===
===Surgery===


*Surgery is the mainstay of therapy for [disease name].
*[[Surgery]] is the mainstay of [[therapy]] or the definitive [[treatment]] for most [[Obstructive jaundice|obstructive]] [[causes]] of [[Conjugated bilirubin|conjugated]] [[hyperbilirubinemia]].
*[Surgical procedure] in conjunction with [chemotherapy/radiation] is the most common approach to the treatment of [disease name].
*Examples of [[Procedure|procedures]] for common [[disorders]] are:
*[Surgical procedure] can only be performed for patients with [disease stage] [disease name].
**[[Choledochoentersotomy]] for [[choledochal cyst]]
**[[Hepatoportoenterostomy]] or the [[Kasai procedure]] for [[biliary atresia]]<ref name="pmid17878208">{{cite journal| author=Kelly DA, Davenport M| title=Current management of biliary atresia. | journal=Arch Dis Child | year= 2007 | volume= 92 | issue= 12 | pages= 1132-5 | pmid=17878208 | doi=10.1136/adc.2006.101451 | pmc=2066090 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17878208  }} </ref>
**Irrigation of the [[biliary tract]] for [[inspissated bile]]
**[[Surgical]] drainage for [[common bile duct]] [[perforation]]
*Timing of [[procedure]] with regards to the [[age]] of [[child]], [[nutritional]] support in the form of [[vitamins]], and [[Calorie|caloric]] replacements are extremely essential for the success of the [[procedure]].
 
===Prevention===
===Prevention===


*There are no primary preventive measures available for [disease name].
*Several [[etiologies]] may be generally difficult to [[prevent]], however, the [[prevention]] of [[complications]] from [[jaundice]] is equally crucial.
*[[Parents]] should be educated on how to recognize [[jaundice]] very early in a [[neonate]] so as to present promptly for the management. Some phone apps and an icterometer are novel means of accurately detecting [[jaundice]].<ref name="pmid30422525">{{cite journal| author=| title=StatPearls | journal= | year= 2020 | volume=  | issue=  | pages=  | pmid=30422525 | doi= | pmc= | url= }} </ref>
*Effective measures for the primary prevention of [disease name] include [measure1], [measure2], and [measure3].
*Appropriate [[vaccinations]] should be received prior to international [[travel]].
 
*[[Prescribed]] [[medications]] should be taken in recommended [[dosages]].
*Once diagnosed and successfully treated, patients with [disease name] are followed-up every [duration]. Follow-up testing includes [test 1], [test 2], and [test 3].
*[[Herbal]] [[medications]] should be avoided unless a [[physician]] clears it.
*[[Smoking]], use of illicit [[drugs]], and excess [[alcohol]] intake should be avoided in [[children]] and [[pregnant]] women.
*Proper [[hand washing]] for [[pregnant]] mothers.


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
 
[[Category:Up-To-Date]]
[[Category:Primary care]]
[[Category:Pediatrics]]
[[Category:Pediatrics]]

Latest revision as of 21:00, 24 February 2021

Jaundice in children Microchapters

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Classification

Pathophysiology

Causes

Differential Diagnosis

Epidemiology and Demographics

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Ifeoma Anaya, M.D.[2]

Synonyms and keywords: Jaundice in kids, hyperbilirubinemia

Overview

The word 'Jaundice' is derived from the French word for yellow, which is jaune. Jaundice may be classified into two broad categories based on its time of onset and cause such as physiologic and pathologic jaundice. Jaundice is caused by high concentrations of bilirubin in the bloodstream, a condition known as hyperbilirubinemia. Hyperbilirubinemia can result from abnormalities in the metabolism of bilirubin which could occur at any stage from its production, which is a result of the excessive breakdown of red blood cells, defects in its hepatic metabolism, and its post hepatic transport. Pathologic causes of jaundice can be classified into causes of conjugated and unconjugated hyperbilirubinemia. Differentials for jaundice are very limited however, some skin discolorations in healthy individuals can look like jaundice in certain circumstances. The prevalence of jaundice varies among patient populations. In infants born at term, 60% will develop jaundice in their first-week of life, which rises to 80% in preterms. Common risk factors in the development of jaundice in children are a family history of jaundice, family history of a child born with jaundice, hyperthyroidism in the mother, medication use by the mother, etc. It is essential for every clinician to note that jaundice is not always a benign condition therefore, extensive investigation of a child with jaundice is necessary to prevent severe complications. Symptoms of jaundice in children may include the yellowish discoloration of skin, sclera, and mucous membrane. A useful technique in assessing the severity of jaundice is by using the principle of skin discoloration progressing in a cephalo-caudal direction in newborns. Laboratory findings include measuring the serum bilirubin from a blood sample. The total and conjugated portions are measured and the unconjugated fraction is measured by subtracting the conjugated fraction from the total. Echocardiography can detect cardiac abnormalities in patients with Alagille syndrome and biliary atresia. Ultrasonography of the abdomen is used to screen for biliary atresia, choledochal cysts, or cholestatic workup in the setting of conjugated hyperbilirubinemia. Treatment options include phototherapy, intravenous immunoglobulin (IVIG), and exchange transfusion. Pharmacological options are also there. Surgery is the mainstay of therapy or the definitive treatment for most obstructive causes of conjugated hyperbilirubinemia. Several etiologies may be generally difficult to prevent however, the prevention of complications from jaundice is equally crucial. Parents should be educated on how to recognize jaundice very early in a neonate so as to present promptly for the management.

Historical Perspective

Classification

Classification of Jaundice
Type of Jaundice Details
Physiologic jaundice
Pathological jaundice[1]

Pathophysiology

Causes

 
 
 
 
 
 
Causes of jaundice in children
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Physiologic
 
 
 
Pathologic
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Unconjugated hyperbilirubinemia
 
 
 
Conjugated hyperbilirubinemia
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Hemolytic
 
 
 
Non-hemolytic
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
•Rh incompatibility
•ABO incompatibility
•Hemoglobinopathies (Thalassemia)
•Hematomas
•Polycythemia
•Sepsis
 
 
 
•Crigler-Najjar syndrome I and II
•Gilbert syndrome
•Breast milk jaundice
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Infectious
 
Obstructive
 
Drugs
 
Genetic/Metabolic
 
Storage disorders
 
Endocirnopathies
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
•Viral
•Bacterial
•Parasitic
 
•Biliary atresia
•Choledochal cyst
•Inspissated bile syndrome
•Neonatal sclerosing cholangitis
•Congenital hepatic fibrosis
•Intrinsic/extrinsic mass
 
•Ceftriaxone
•Isoniazid
•Erythromycin
•Rifampin
•Sulfa drugs
•Parenteral nutrition
•Methotrexate
 
•Alpha 1 antitrypsin deficiency
•Alagille syndrome
•Cystic fibrosis
•Tyrosinemia
•Galactosemia
•Rotor syndrome
•Trisomy 18 and Trisomy 21
 
•Gaucher's Disease
•Niemann-pick Disease
•Glycogen storage diseases
•Mucolipidoses
 
•Hypopituitarism
•Hypothyroidism
•McCune Albright syndrome
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

Differentiating jaundice in children from other diseases

Epidemiology and Demographics

Age

Gender

Race

Risk Factors

Natural History, Complications and Prognosis

Diagnosis

Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

X-ray

Echocardiography and Ultrasound

CT scan

MRI

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Prevention

References

  1. ↑ 1.0 1.1 1.2 1.3 1.4 1.5 1.6 1.7 "StatPearls". 2020. PMID 30422525.
  2. ↑ Mittendorf R, Williams MA (1991). "Rho(D) immunoglobulin (RhoGAM): how it came into being". Obstet Gynecol. 77 (2): 301–3. doi:10.1097/00006250-199102000-00029. PMID 1846439.
  3. ↑ Weiss EM, Zimmerman SS (2013). "A tale of two hospitals: the evolution of phototherapy treatment for neonatal jaundice". Pediatrics. 131 (6): 1032–4. doi:10.1542/peds.2012-3651. PMID 23650299.
  4. ↑ 4.0 4.1 4.2 4.3 4.4 4.5 4.6 "StatPearls". 2020. PMID 31334972.
  5. ↑ Mishra S, Agarwal R, Deorari AK, Paul VK (2008). "Jaundice in the newborns". Indian J Pediatr. 75 (2): 157–63. doi:10.1007/s12098-008-0024-7. PMID 18334797.
  6. ↑ 6.0 6.1 6.2 Chee YY, Chung PH, Wong RM, Wong KK (2018). "Jaundice in infants and children: causes, diagnosis, and management". Hong Kong Med J. 24 (3): 285–292. doi:10.12809/hkmj187245. PMID 29807950.
  7. ↑ Mojtahedi SY, Izadi A, Seirafi G, Khedmat L, Tavakolizadeh R (2018). "Risk Factors Associated with Neonatal Jaundice: A Cross-Sectional Study from Iran". Open Access Maced J Med Sci. 6 (8): 1387–1393. doi:10.3889/oamjms.2018.319. PMC 6108787. PMID 30159062.
  8. ↑ Kelly DA, Davenport M (2007). "Current management of biliary atresia". Arch Dis Child. 92 (12): 1132–5. doi:10.1136/adc.2006.101451. PMC 2066090. PMID 17878208.
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