Makindo Medical Notes

⚠️ Do not miss the diagnosis of biliary atresia.

📖 About

• Jaundice in the first 24 hours of life = always pathological.
• Physiological jaundice appears after 24 hrs, resolves within 2 weeks, and is mostly unconjugated.
• Biliary atresia → conjugated hyperbilirubinaemia. Severe unconjugated hyperbilirubinaemia (>360 µmol/L) risks kernicterus 🧠.

TSB (Total Serum Bilirubin) measures bilirubin in blood. Elevated bilirubin = jaundice (yellow skin/eyes). Persistent or conjugated rise suggests underlying disease.

🦠 Causes of Neonatal Jaundice

✅ Physiological Jaundice

• Appears >24 hrs of life
• Peaks at day 3–5
• Resolves within 1–2 weeks
• Usually no treatment; monitor TSB

🤱 Breast Milk Jaundice

• Begins after 1st week, can persist 4–6 weeks
• Exclude other causes of prolonged jaundice
• Continue breastfeeding, monitor TSB

🩸 Haemolytic Disease (ABO/Rh incompatibility)

• Jaundice within 24 hrs
• Splenomegaly, pallor
• Tests: Direct Coombs, blood group/Rh, TSB, Hb
• Management: Phototherapy; exchange transfusion if severe

🦠 Neonatal Sepsis

• Jaundice + infection signs (poor feeding, lethargy, temperature instability)
• Tests: Blood culture, CRP, FBC, TSB
• Management: IV antibiotics + phototherapy

🚫 Biliary Atresia

• Jaundice persisting >2 weeks
• Pale stools, dark urine
• Tests: USS, LFTs, hepatobiliary scintigraphy
• Management: Kasai procedure; liver transplant if severe

🧬 Crigler–Najjar Syndrome

• Severe jaundice from birth
• Neurological symptoms (kernicterus) if untreated
• Tests: TSB, genetic testing (UGT1A1 mutation)
• Management: Phototherapy; possible liver transplant

📈 Why TSB is Important

• Helps determine jaundice severity & need for intervention (e.g., phototherapy, exchange transfusion).
• Prevents progression to kernicterus 🧠.
• Normal TSB varies with age in hours, but jaundice visible >5 mg/dL;>20 mg/dL requires urgent action.