JAUNDICE - Common Patterns Pediatric

1)      Physiological jaundice – starts on the second day of life, lasts for 2-3 days, disappears by 7th day, elevated bilirubin is unconjugated, hyperbilirubinemia causes jaundice at 4-5 mg/dL, as hyperbilirubinemia rises jaundice advances head to toe, visible jaundice on feet is an indication for serum bilirubin, a useful rule of the thumb is jaundice in the face (bilirubin 4-8 mg/100 ml), upper trunk (bilirubin 5-12 mg/100 ml), lower trunk and thighs (bilirubin 8-16 mg/100 ml), arms and lower legs (bilirubin 11-18 mg/100 ml), palms and soles (bilirubin > 15 mg/100 ml), physiological jaundice does not exceed 15 mg/dL, Mx – usually resolves within1 week, frequent formula feeding reduce incidence and severity of hyperbilirubinemia,

2)      Breast Milk Jaundice – appears on the 4-7th day, disappears with stopping breast milk, and reappears with breastfeeds, harmless, with no risk of kernicterus, usually disappears, unconjugated hyperbilirubinemia, decreased milk intake and dehydration  and low caloric intake as when water replaces the breastmilk, are risk factors, Mx – increase the frequency of feeds, minimize the use of water to replace breast milk, further treatment guided by the bilirubin levels

3)      Carotenemia – yellow pigment in food, sclera clear

4)      Lycopenemia – orange pigment in foods, clear

5)      Viral hepatitis – fever, anorexia, abdominal pain, tender hepatomegaly, splenomegaly, bile-stained urine, clay-colored stools, 

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