Physiological Jaundice: Pathogenesis, Management, Risk

Physiological Jaundice

What is Physiological Jaundice?
Physiological Jaundice of the newborn usually appears after 30 hours, the peak level of bilirubin is reached on the 4the and 5th days and disappears by 7 days. Bilirubin level does not usually exceed 10mg/dl.


Pathogenesis

Hepatic immaturity during the first few days of life.

Enterohepatic recirculation of bilirubin may be responsible for physiological jaundice.

Physiological Jaundice may be exaggerated in the following circumstances:
  • Prematurity: The rate of maturation of liver functions is slower in premature infants.
  • Hypoxia and circulatory insufficiency: In circulatory insufficiency, an increased number of RBC are sequestrated in the lungs, the cells hemolysis, and increase in bilirubin load.
Drugs: Physiological jaundice is exaggerated by following drugs, e.g, Novobiocin, Salicylates, Diazepam, etc.
Role of Cephalhematoma: Every gm of hemoglobin liberates 34mg of bilirubin on hemolysis.
Role of infections: Intrauterine infections with Toxoplasmagondii, cytomegalovirus, or Syphilis.


Management

Symptomatic treatment.

The newborn child ought to be looked for any entangling disease or unexpected ascent of bilirubin level.


High-risk signs in Jaundiced infants

Family history of hemolytic disease

Vomiting

Lethargy

Poor feeding

Fever

The onset of jaundice after 3rd day

Dark urine

Light stools


Bilirubin level and treatment

16-25mg/dl - Stop breastfeeding

17.5-22mg/dl - Phototherapy

>25mg/dl - Exchange transfusion


Indication and test

Suspected hemolytic disease, 1st-day jaundice or TB>14mg/dl - Complete blood count

Anemic infant in whom other is suspicion of hemolysis due to causes other than isoimmunization - Reticulocyte count

Persistent jaundice (beyond 2weeks) - Direct bilirubin levels.


Physiological jaundice vs Pathological jaundice

The physiology of the newborn is different from that of older children and adults in many ways. Infants breathe 40 to 60 times per minute, and their hearts beat 120 to 160 times per minute. Their hematocrit levels are typical> 60%. Over time, all of these values ​​return to normal levels, as do their bilirubin levels. However, we are not talking about physiologic tachypnea, tachycardia, or polycythemia, so why choose jaundice?

Some prefer the term "physiologic jaundice" because it has the reassuring sound of parents and doctors. Obviously, physiologic jaundice should work in newborns with TSB levels falling below a certain level, but what is that stage? Because there are very few (if any) newborns with high levels of TSB <2 mg / dL, can a baby with a high TSB level of 1.5 mg / dL be considered abnormal or hypobilirubinemic? In contrast to serum sodium levels, the range of normal TSB levels varies greatly depending on population, breastfeeding events, and other genetic and epidemiologic diseases.


Homeopathic medicine (Expert Homeopathy: Dr. Anutosh Chakraborty)

China, Chelidonium M, Chamomilla are good medicine for physiological jaundice.


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