Jaundice resident survival guide (pediatrics)

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Asra Firdous, M.B.B.S.[2]

Synonyms and Keywords:

Jaundice resident survival guide (pediatrics) Microchapters
Overview
Causes
FIRE
Diagnosis
Treatment
Do's
Don'ts

Overview

This section provides a short and straight to the point overview of the disease or symptom. The first sentence of the overview must contain the name of the disease.

Causes

Life Threatening Causes

Life-threatening causes include conditions that may result in death or permanent disability within 24 hours if left untreated.[1][2]

Common Causes

Causes of jaundice in children include:[3][1]

Common causes of Jaundice in children
Unconjugated hyperbilirubinemia Conjugated hyperbilirubinemia
Hepatic etiology Post-hepatic etiology

FIRE: Focused Initial Rapid Evaluation

Complete Diagnostic Approach

Shown below is an algorithm summarizing the diagnosis of jaundice in children.


 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Obtain a detailed history
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Examine the patient
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Order serum bilirubin
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Increased indirect bilirubin
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Increased direct bilirubin
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Unconjugated hyperbilirubinemia
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Conjugated hyperbilirubinemia
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Pathological jaundice
 
 
 
 
 
Physiological jaundice
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Liver function test
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Features of hemolysis
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Increased ALT and AST
 
 
 
Increased ALP and GGT
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Present
 
 
Absent
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Hemolytic anemia
❑ Family history of anemia
❑ African-American or African race
Pallor
Fatigue
Fever
Chills
Hemoglobinuria
Splenomegaly
Gallstone
 
 

Breast milk jaundice

Breastfeeding history
Healthy infant
❑ Absence of other abnormalities

Breast feeding jaundice

❑ Inadequate breastfeeding
Signs of dehydration

Gilbert syndrome

❑ Mild jaundice seen in neonates
❑ Positive family history
❑ Aggravated by exertion, stress, illness, fasting, infection
❑ Recurrent episodes of jaundice

Crigler-Najjar syndrome

Neonatal jaundice
❑ Positive family history
❑ Recurrent episodes of jaundice
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Diagnostic work up
❑ Normal blood profile
❑ Normal LFT
❑ Normal liver histology
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Diagnostic work up

Viral Hepatitis

CBC with differentials
Hepatitis serology
Monospot test and Heterophile antibody test
EBV serology
HSV serology

Wilson's disease

❑ Low serum ceruloplasmin
❑ High serum calcium
❑ 24-hour urinary copper excretion more than 100 μg/24h
Coombs negative hemolytic anemia
Liver bopsy

Metabolic syndrome

Newborn screening tests
 
 
 
Diagnostic work up

Biliary atresia

Cholestatic pattern on LFT
❑ Small or absent gall bladder on abdominal ultrasonography
ERCP
Hepatobiliary scintigraphy
❑ Intraoperative cholangiogram
Liver biopsy

Choledochal cyst

LFT
Abdominal ultrasonography
ERCP and MRCP

Inspissated bile syndrome

Abdominal ultrasonography
❑ Intraperative cholangiogram

Gallstone

LFT
❑ Serum amylase and lipase
CBC with differentials
❑ Transabdominal ultrasonography

Treatment

Shown below is an algorithm summarizing the treatment of jaundice in kids.



 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Jaundice
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Unconjugated hyperbilirubinemia
 
 
 
 
 
 
 
 
 
 
 
 
Conjugated hyperbilirubinemia
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Hemolytic anemia
 
 
 
Non-hemolytic causes of jaundice
 
 
 
Physiological jaundice
❑ Reassure
 
 
 
Hepatic etiology
 
 
 
Post-hepatic etiology
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Blood transfusion
Erythropoietin
❑ Immunosuppression
Treat the underlying cause
 
 
 

Breast milk jaundice

❑ Spontaneously resolves within 12 weeks
❑ Reassure and follow-up
❑ Continue breast feeding
Phototherapy

Breast feeding jaundice

❑ Increase the frequency of breast feeding
❑ Adequate hydration
Monitor bilirubin levels
Formula feeding if no improvement
Phototherapy

Gilbert syndrome

❑ No treatment
❑ Reassurance
Patient education about the excellent prognosis

Crigler-Najjar syndrome

Phenobarbital
Phototherapy
Plasmapheresis
Exchange transfusion
❑ Long term monitoring
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

Do's

Don'ts

References

  1. 1.0 1.1 1.2 Pashankar, D.; Schreiber, R. A. (2001). "Jaundice in Older Children and Adolescents". Pediatrics in Review. 22 (7): 219–226. doi:10.1542/pir.22-7-219. ISSN 0191-9601.
  2. Chee, YY; Chung, Patrick HY; Wong, Rosanna MS; Wong, Kenneth KY (2018). "Jaundice in infants and children: causes, diagnosis and management". Hong Kong Medical Journal. doi:10.12809/hkmj187245. ISSN 1024-2708.
  3. "Jaundice causes: MedlinePlus Medical Encyclopedia".
  4. Salih FM (2001). "Can sunlight replace phototherapy units in the treatment of neonatal jaundice? An in vitro study". Photodermatol Photoimmunol Photomed. 17 (6): 272–7. doi:10.1034/j.1600-0781.2001.170605.x. PMID 11722753.
  5. Fretzayas A, Moustaki M, Liapi O, Karpathios T (2012). "Gilbert syndrome". Eur J Pediatr. 171 (1): 11–5. doi:10.1007/s00431-011-1641-0. PMID 22160004.