Jaundice in children: Difference between revisions

Jump to navigation Jump to search
VisualWikitext
Line 85: Line 85:
{{CMG}} {{AE}}{{Ifeoma Anaya}}
{{CMG}} {{AE}}{{Ifeoma Anaya}}


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


==Overview==
==Overview==
The word '[[Jaundice]]' was 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; [[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]]. This 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 mother, [[medication]] use by 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 following: yellowish discoloration of the [[skin]], [[sclera]], and [[mucous membrane]], time of onset, [[duration]], and [[progression]].  [[Patients]] with [[jaundice]] usually 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]]. [[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 do exist. [[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 management.
The word '[[Jaundice]]' was 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, [[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]]. This 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 mother, [[medication]] use by 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 following: yellowish discoloration of the [[skin]], [[sclera]], and [[mucous membrane]], time of onset, [[duration]], and [[progression]].  [[Patients]] with [[jaundice]] usually 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]]. [[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 do exist. [[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 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>
*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>
*Very early records of '''''[[Icterus]] neonatorum''''' dates 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]].
*Very early records of '''''[[Icterus]] neonatorum''''' dates 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]].
*'''''[[Icterus]] gravis''''', a more dire presentation was better understood in the 1940s when advances in [[immunology]] and [[genetics]] led to the discovery of the Rh group of [[red cell]] [[antigens]]. It explained its recurrent nature in families after a first [[child]] becomes affected. These advances in also birthed effective [[treatment]] modalities alongside [[screening]] methods that included [[maternal]] [[serology]] and [[amniocentesis]] in the [[perinatal]] period.  
*'''''[[Icterus]] gravis''''', a more dire presentation was better understood in the 1940s when advances in [[immunology]] and [[genetics]] led to the discovery of the Rh group of [[red cell]] [[antigens]]. It explained its recurrent nature in families after a first [[child]] becomes affected. These advances in also birthed effective [[treatment]] modalities alongside [[screening]] methods that included [[maternal]] [[serology]] and [[amniocentesis]] in the [[perinatal]] period.
*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-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>  
*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-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]] literarily became ''less yellow'' than before. Subsequently, [[lab]] [[results]] further confirmed this 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>
*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]] literarily became ''less yellow'' than before. Subsequently, [[lab]] [[results]] further confirmed this 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 its time of onset and cause.
*[[Jaundice]] may be classified into two broad categories based on its time of onset and cause.
**'''[[Physiologic]] [[jaundice]]''':
**'''[[Physiologic]] [[jaundice]]''':
***Seen after the first 24 hours of life.
***Seen after the first 24 hours of life.
***[[Serum bilirubin]] never exceeds >5mg/dl daily and maximum [[concentration]] is about 12mg/dl and 14mg/dl in full terms and [[preterms]] respectively.
***[[Serum bilirubin]] never exceeds >5mg/dl daily and maximum [[concentration]] is about 12mg/dl and 14mg/dl in full terms and [[preterms]] respectively.
***Highest levels are attained in the 4th-5th days and resolve within 2 weeks in both full-term and [[preterm]] [[infants]].  
***Highest levels are attained in the 4th-5th days and resolve within 2 weeks in both full-term and [[preterm]] [[infants]].
***[[Infants]] usually appear well.
***[[Infants]] usually appear well.
**'''Pathological [[jaundice]]''':
**'''Pathological [[jaundice]]''':
Line 110: Line 112:


==Pathophysiology==
==Pathophysiology==
*[[Jaundice]] is caused by high [[concentrations]] of [[bilirubin]] in the [[bloodstream]]. A condition known as [[Hyperbilirubinemia]].
*[[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 as a result of the excessive [[breakdown]] of [[red blood cells]], defects in its [[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]], defects in its [[hepatic]] [[metabolism]], and its post [[hepatic]] transport.
*[[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>
*[[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>
*[[Water]]-insoluble [[bilirubin]] 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 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 conjugated form of [[bilirubin]] is secreted into [[bile]] and then into the [[small intestine]] after being stored in the [[gall bladder]]. 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]].  
*This conjugated form of [[bilirubin]] is secreted into [[bile]] and then into the [[small intestine]] after being stored in the [[gall bladder]]. 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]].
*[[Hyperbilirubinemia]] whether conjugated or unconjugated gives a clue as to the defective point in the [[metabolism]] of [[bilirubin]].
*[[Hyperbilirubinemia]] whether conjugated or unconjugated gives a clue as to the defective point in the [[metabolism]] of [[bilirubin]].


==Causes==
==Causes==
*Causes of [[jaundice]] in [[children]] can be classified as follows:
*Causes of [[jaundice]] in [[children]] can be classified as follows:
{{familytree/start}}
{{familytree/start}}
Line 144: Line 148:


==Differentiating Jaundice in children from other Diseases==
==Differentiating Jaundice in children from other Diseases==
*Alternative diagnosis for [[jaundice]] are limited however, some [[skin]] discolorations in [[healthy]] individuals can reemble [[jaundice]] in certain circumstances.
*Alternative diagnosis for [[jaundice]] are limited however, some [[skin]] discolorations in [[healthy]] individuals can reemble [[jaundice]] in certain circumstances.
*Use of the [[antimalarial]] and [[antihelminthic]] [[drug]], [[Quinacrine]] can cause yellowish discoloration of the [[skin]] of individuals who take it.
*Use of the [[antimalarial]] and [[antihelminthic]] [[drug]], [[Quinacrine]] can cause yellowish discoloration of the [[skin]] of individuals who take it.
Line 150: Line 155:


==Epidemiology and Demographics==
==Epidemiology and Demographics==
*The [[prevalence]] of [[jaundice]] varies among [[patient]] [[populations]].
*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>
*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>  
*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]].
*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>
*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 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]] [[populations]]. <ref name="pmid31334972">{{cite journal| author=| title=StatPearls | journal= | year= 2020 | volume=  | issue=  | pages=  | pmid=31334972 | doi= | pmc= | url= }} </ref>
   
   
===Gender===
===Gender===
*[[Gender]] preference 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 ([[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]].  
 
*A [[genetic]] [[mutation]] in the [[gene]] responsible for the production of the [[enzyme]], UDPGT is its cause. [[Diagnosis]] is made only when alternative explanations have been ruled out. [[Symptoms]] are triggered by stressful situations like [[dehydration]], illness.  
*Racial predilection for [[jaundice]] is observed in a cause of unconjugated [[hyperbilirubinemia]], [[Gilbert syndrome]].
*A [[genetic]] [[mutation]] in the [[gene]] responsible for the production of the [[enzyme]], UDPGT is its cause. [[Diagnosis]] is made only when alternative explanations have been ruled out. [[Symptoms]] are triggered by stressful situations like [[dehydration]], 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]] in the development of [[jaundice]] in [[children]] are:  
**[[Family history]] of [[jaundice]]
**[[Family history]] of [[jaundice]]
Line 194: Line 204:


==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 investigation of a child with [[jaundice]] is necessary to prevent severe [[complications]].
*In the setting of very high unconjugated [[bilirubin]] levels, a rare [[complication]] known as [[Bilirubin]]-induced [[neurological]] dysfunction (BIND) is observed.  
*In the setting of very high unconjugated [[bilirubin]] levels, a rare [[complication]] known as [[Bilirubin]]-induced [[neurological]] dysfunction (BIND) is observed.
*Elevated levels of unconjugated [[bilirubin]] crosses the immature [[blood-brain-barrier]] of [[neonates]] binding 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 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:
Line 210: Line 221:
**[[Cerebral palsy]]
**[[Cerebral palsy]]
**Learning problems
**Learning problems
**Loss of [[hearing]]  
**Loss of [[hearing]]
*[[Complications]] from the causes of conjugated [[hyperbilirubinemia]] include:
*[[Complications]] from the causes of conjugated [[hyperbilirubinemia]] include:
**[[Liver failure]]
**[[Liver failure]]
Line 223: Line 234:
==Diagnosis==
==Diagnosis==
===Symptoms===
===Symptoms===
*[[Symptoms]] of [[Jaundice]] in [[children]] may include the following:
*[[Symptoms]] of [[Jaundice]] in [[children]] may include the following:
**[[Skin]], [[sclera]], and [[mucous membrane]] discoloration.
**[[Skin]], [[sclera]], and [[mucous membrane]] discoloration.
Line 241: Line 253:


===Physical Examination===
===Physical Examination===
*[[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]].  
 
*[[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]].
*If [[discoloration]] has progressed to the [[thigh]] level, [[samples]] for urgent [[serum bilirubin]] should be taken.
*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]].
*This method is not necessary for [[infants]] who are already receiving [[phototherapy]] and those with darker colored [[skin]].
Line 248: Line 261:
**[[Fever]]
**[[Fever]]
**[[Rash]]
**[[Rash]]
**[[Examine]] [[urine]] and [[stool]]  
**[[Examine]] [[urine]] and [[stool]]
**Small or large for age
**Small or large for age
**[[Lymph node]] enlargement
**[[Lymph node]] enlargement
Line 259: Line 272:


===Laboratory Findings===
===Laboratory Findings===
*Measuring the level of [[bilirubin]].
*Measuring the level of [[bilirubin]].
**[[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.
**[[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.
**Knowing the type of [[hyperbilirubinemia]] will guide further workup in identifying the cause of [[jaundice]]. Conjugated or mixed [[hyperbilirubinemia]] gives a speculation of  [[hepatic]] or post-[[hepatic]] [[etiology]].
**Knowing the type of [[hyperbilirubinemia]] will guide further workup in identifying the cause of [[jaundice]]. Conjugated or mixed [[hyperbilirubinemia]] gives a speculation of  [[hepatic]] or post-[[hepatic]] [[etiology]].
**Transcutaneous bilirubinometer. The accuracy of this can be altered by [[skin]] thickness and color.  
**Transcutaneous bilirubinometer. The accuracy of this can be altered by [[skin]] thickness and color.
**Bilimeter
**Bilimeter
*[[Complete blood count]] with differentials and smear
*[[Complete blood count]] with differentials and smear
Line 291: Line 305:
**[[EBV]]
**[[EBV]]
**[[Parvovirus B19]]
**[[Parvovirus B19]]
*[[Serum]] [[ammonia]]  
*[[Serum]] [[ammonia]]
*[[Blood cultures]]
*[[Blood cultures]]
*[[Urinalysis]]
*[[Urinalysis]]
Line 302: Line 316:


===Electrocardiogram===
===Electrocardiogram===
*There are no [[ECG]] findings associated with [[Jaundice]] in [[children]].  
 
*There are no [[ECG]] findings associated with [[Jaundice]] in [[children]].
*It may be used to monitor [[cardiac]] rhythms during [[treatment]].
*It may be used to monitor [[cardiac]] rhythms during [[treatment]].


===X-ray===
===X-ray===
*[[Chest radiograph]] can reveal [[cardiomegaly]] in individuals with [[Alagille syndrome]].
*[[Chest radiograph]] can reveal [[cardiomegaly]] in individuals with [[Alagille syndrome]].


===Echocardiography and Ultrasound===
===Echocardiography and Ultrasound===
*[[Echocardiography]] can detect [[cardiac]] abnormalities in patients with [[Alagille syndrome]] and [[biliary atresia]].
 
*[[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]].<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>
*[[Ultrasonography]] of the [[abdomen]] is used to [[screen]] for [[biliary atresia]], [[choledochal cysts]] or [[cholestatic]] workup in the setting of 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>


===CT scan===
===CT scan===
*[[CT scan]] of the [[abdomen]] is used to [[screen]] for [[biliary atresia]], [[choledochal cysts]], or [[cholestatic]] workup in the setting of conjugated [[hyperbilirubinemia]].
*[[CT scan]] of the [[abdomen]] is used to [[screen]] for [[biliary atresia]], [[choledochal cysts]], or [[cholestatic]] workup in the setting of conjugated [[hyperbilirubinemia]].


===MRI===
===MRI===
*[[MRI]] is used to [[screen]] for [[biliary atresia]], [[choledochal cysts]], or [[cholestatic]] workup in the setting of conjugated [[hyperbilirubinemia]].
*[[MRI]] is used to [[screen]] for [[biliary atresia]], [[choledochal cysts]], or [[cholestatic]] workup in the setting of conjugated [[hyperbilirubinemia]].


===Other Imaging Findings===
===Other Imaging Findings===
*Other imaging modalities used for [[screening]] for [[cholestatic]] workup include the following:
*Other imaging modalities used for [[screening]] for [[cholestatic]] workup include the following:
**[[Magnetic resonance cholangiopancreatography]] ([[MRCP]])
**[[Magnetic resonance cholangiopancreatography]] ([[MRCP]])
**[[Endoscopic retrograde cholangiopancreatography]] ([[ERCP]])
**[[Endoscopic retrograde cholangiopancreatography]] ([[ERCP]])
**Hepatobiliary scintigraphy with technetium-labeled iminodiacetic acid analog (HIIDA)  
**Hepatobiliary scintigraphy with technetium-labeled iminodiacetic acid analog (HIIDA)
**[[Percutaneous transhepatic cholangiography]] (PTC)
**[[Percutaneous transhepatic cholangiography]] (PTC)


===Other Diagnostic Studies===
===Other Diagnostic Studies===
*[[Diagnostic]] [[laparoscopy]] with/without [[treatment]]  
 
*[[Diagnostic]] [[laparoscopy]] with/without [[treatment]]
*[[Liver biopsy]]
*[[Liver biopsy]]


==Treatment==
==Treatment==
===Medical Therapy===
===Medical Therapy===
*[[Treatment]] of [[Jaundice]] is usually tailored towards the underlying [[etiology]] whether it a [[hematologic]] [[disease]] or a [[hepatobiliary]] [[pathology]].<ref name="pmid31334972">{{cite journal| author=| title=StatPearls | journal= | year= 2020 | volume=  | issue=  | pages=  | pmid=31334972 | doi= | pmc= | url= }} </ref>
*[[Treatment]] of [[Jaundice]] is usually tailored towards the underlying [[etiology]] whether it a [[hematologic]] [[disease]] or a [[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:
*[[Treatment]] options include the following:
Line 337: Line 359:
**[[Exchange transfusion]]: When the above options become inadequate to reduce 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]] like:<ref name="pmid30422525">{{cite journal| author=| title=StatPearls | journal= | year= 2020 | volume=  | issue=  | pages=  | pmid=30422525 | doi= | pmc= | url= }} </ref>
**[[Exchange transfusion]]: When the above options become inadequate to reduce 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]] like:<ref name="pmid30422525">{{cite journal| author=| title=StatPearls | journal= | year= 2020 | volume=  | issue=  | pages=  | pmid=30422525 | doi= | pmc= | url= }} </ref>
***[[Cardiac arrhythmias]]
***[[Cardiac arrhythmias]]
***[[Sepsis]]  
***[[Sepsis]]
***[[Hyperkalemia]]
***[[Hyperkalemia]]
***[[Hypocalcemia]]
***[[Hypocalcemia]]
Line 349: Line 371:


===Surgery===
===Surgery===
*[[Surgery]] is the mainstay of therapy or the definitive [[treatment]] for most obstructive causes of conjugated [[hyperbilirubinemia]].  
 
*[[Surgery]] is the mainstay of therapy or the definitive [[treatment]] for most obstructive causes of conjugated [[hyperbilirubinemia]].
*Examples of procedures for common [[disorders]] are:  
*Examples of procedures for common [[disorders]] are:  
**[[Choledochoentersotomy]] for [[choledochal cyst]]
**[[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>
**[[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]]
**Irrigation of the [[biliary tract]] for [[inspissated bile]]
**[[Surgical]] drainage for [[common bile duct]] [[perforation]]  
**[[Surgical]] drainage for [[common bile duct]] [[perforation]]
*Timing of [[procedure]] with regards to the age of the [[child]], [[nutritional]] support in the form of [[vitamins]], and caloric replacements are extremely essential for the success of the [[procedure]].
*Timing of [[procedure]] with regards to the age of the [[child]], [[nutritional]] support in the form of [[vitamins]], and caloric replacements are extremely essential for the success of the [[procedure]].


===Prevention===
===Prevention===
*Several etiologies may be generally difficult to [[prevent]] however the [[prevention]] of [[complications]] from [[jaundice]] is equally crucial.  
 
*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 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>
*[[Parents]] should be educated on how to recognize [[jaundice]] very early in a [[neonate]] so as to present promptly for 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>
*Appropriate [[vaccinations]] should be received prior to international [[travels]].
*Appropriate [[vaccinations]] should be received prior to international [[travels]].

Revision as of 21:16, 22 December 2020

Jaundice in children Microchapters

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differential Diagnosis

Epidemiology and Demographics

Risk factors

Natural History, Complications and Prognosis

Diagnosis

Treatment

Prevention

WikiDoc Resources for Jaundice in children

Articles

Most recent articles on Jaundice in children

Most cited articles on Jaundice in children

Review articles on Jaundice in children

Articles on Jaundice in children in N Eng J Med, Lancet, BMJ

Media

Powerpoint slides on Jaundice in children

Images of Jaundice in children

Photos of Jaundice in children

Podcasts & MP3s on Jaundice in children

Videos on Jaundice in children

Evidence Based Medicine

Cochrane Collaboration on Jaundice in children

Bandolier on Jaundice in children

TRIP on Jaundice in children

Clinical Trials

Ongoing Trials on Jaundice in children at Clinical Trials.gov

Trial results on Jaundice in children

Clinical Trials on Jaundice in children at Google

Guidelines / Policies / Govt

US National Guidelines Clearinghouse on Jaundice in children

NICE Guidance on Jaundice in children

NHS PRODIGY Guidance

FDA on Jaundice in children

CDC on Jaundice in children

Books

Books on Jaundice in children

News

Jaundice in children in the news

Be alerted to news on Jaundice in children

News trends on Jaundice in children

Commentary

Blogs on Jaundice in children

Definitions

Definitions of Jaundice in children

Patient Resources / Community

Patient resources on Jaundice in children

Discussion groups on Jaundice in children

Patient Handouts on Jaundice in children

Directions to Hospitals Treating Jaundice in children

Risk calculators and risk factors for Jaundice in children

Healthcare Provider Resources

Symptoms of Jaundice in children

Causes & Risk Factors for Jaundice in children

Diagnostic studies for Jaundice in children

Treatment of Jaundice in children

Continuing Medical Education (CME)

CME Programs on Jaundice in children

International

Jaundice in children en Espanol

Jaundice in children en Francais

Business

Jaundice in children in the Marketplace

Patents on Jaundice in children

Experimental / Informatics

List of terms related to Jaundice in children

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' was 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, 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. This 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 mother, medication use by 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 following: yellowish discoloration of the skin, sclera, and mucous membrane, time of onset, duration, and progression. Patients with jaundice usually 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. 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 do exist. 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 management.

Historical Perspective

Classification

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.
Retrieved from "https://www.wikidoc.org/index.php?title=Jaundice_in_children&oldid=1679933"