BIOSOFT HELP FILES

1)      Physiological jaundice – starts on the second day of life, lasts for 2-3 days, disappears by 7^th 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 4-7^th 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, 

1)      First-day jaundice (hemolytic disease of newborns until proven otherwise, immediate referral to a neonatal unit)

2)      Jaundice appearing after the first week (metabolic screening for congenital hypothyroidism, galactosemia, etc)

3)      Bilirubin level above 10 mg/dL (170 mmols/L) in preterm infants and 18 mg/dL (308 mmols/L) in term infants needs investigation

4)      Dark urine (yellow stain of nappies ) and/or pale stools  (Hepatobiliary disease, neonatal hepatitis)

5)      Jaundice persisting for more than 14 days

6)      Family history of jaundice (hereditary hemolytic anemias, benign hyperbilirubinemias)

7)      Rapid appearance and quick progression of jaundice after 4^th day of life (Sepsis until proven otherwise, referral to a pediatric unit essential)

8)      Twitchiness, fits, dyskinesia (? kernicterus)

9)      Anemia

10)    Elevation of mainly conjugated bilirubin

11)    Maternal illness suggestive of viral infection

12)    Postnatal symptoms like loss of stool color, refusal of feeds, greater than average weight loss,  symptoms and signs of hypothyroidism, symptoms and signs of metabolic diseases,

13)    Neurological symptoms and signs in a jaundiced baby – drowsiness, hyper or hypotonia, seizures or jitteriness, altered cry, poor Moro’s reflex, opisthotonus (impending kernicterus)

14)    Hepatosplenomegaly, petechiae, microcephaly, hemolytic anemia (sepsis, congenital infections)

15)    Direct bilirubin > 2 mg/dl at any time

(Illingworth 1983)

(Merck Manuals Online Medical Library 2008)

(Hansen 2007)

Usually arriving at pessimistic conclusions based on past experiences.  Eg. I cannot get through the exam because previous attempt too failed.