Follow up of icteric neonates .

March 10, 201411 yr

In the follow up of neonates ( who was admitted to our unite in first week of life for photo-therapy duo to exaggerated physiological jaundice ) i some times notice that there is still a tinge of jaundice seen in the skin at the age of one month , is this normal or i need to order some investigations for these neonates ?

Mohamad Ismail

Neonatology resident

Mansoura

Egypt .

March 10, 201411 yr

Order a direct/indirect bilirubin levels to see it is conjugated or not, do liver enzymes level to rule out liver pathology, if everything ok wait bad follow up.

March 11, 201411 yr

These neonates are full-term or premature? Do you know some informations from familly history: e.g. m.Gilbert ...and they have breast milk (competitive inhibition) or formula?

March 12, 201411 yr

Author

Most of these neonates are full-term with no relevant family history and they have breast milk only .

What is the acceptable range of indirect serum bilirubin at age of one month ?

March 13, 201411 yr

Most of these neonates are full-term with no relevant family history and they have breast milk only .

What is the acceptable range of indirect serum bilirubin at age of one month ?

I agree that these babies are often just well term and breast-fed babies. Breast milk is often blamed to be the cause of prolonged jaundice, but we seldom paus breastfeeding on this indication (any longer) but monitor s-bilirubin and relative often do a liver function work-up.

Regarding levels: my personal take is that the baby should be clearly under the limit for photo-therapy, BUT that the most important aspect is the dynamics of the bilirubin-level, i.e. that the level decreases over time. A persisting high unconjugated s-bilirubin should lead to further investigations (liver function tests, metabolic screens etc)

The NICE document (which is really good!) about neonatal hyperbili gives only vague guidelines on prolonged hyperbili (http://guidance.nice.org.uk/CG98) but I still want to high-light the the threshold graph (excel-based, http://guidance.nice.org.uk/CG98/treatmentthresholdgraph/xls/English)