What is hyperbilirubinemia in the neonatal period?
Almost all hyperbilirubinemia in the immediate neonatal period is unconjugated, which is termed indirect bilirubin, based on older laboratory measurement methods; conjugated bilirubin is termed direct bilirubin. For further discussions of cholestasis and disorders of bilirubin excretion in the neonatal period see neonatal cholestasis.
What are the management goals for bilirubin in neonatal?
The management goals are to exclude pathologic causes of hyperbilirubinemia and initiate treatment to prevent bilirubin neurotoxicity. Neonatal hyperbilirubinemia, defined as a total serum bilirubin level above 5 mg per dL (86 μmol per L), is a frequently encountered problem.
Can a baby with Down syndrome have hyperbilirubinemia?
Conclusions: Neonates with Down syndrome have a substantial risk of early hyperbilirubinemia. The American Academy of Pediatrics currently advises obtaining an early screening complete blood count from neonates with Down syndrome. We submit that assessing their TSB is also advisable.
When to start phototherapy for neonatal hyperbilirubinemia?
There are now suggested operational thresholds to initiate phototherapy based on gestational age. Neurotoxicity is the major consequence of neonatal hyperbilirubinemia.
When to use a transcutaneous bilirubin nomogram?
Transcutaneous bilirubin (TcB) nomogram for assessing the risk of subsequent significant hyperbilirubinemia in healthy term and near-term newborns. The high-risk zone is defined by the track of TcB values with positive likelihood ratio greater than 10, and the low-risk zone by the track of TcB values with negative likelihood ratio less than 0.1.
How does bilirubin affect the development of kernicterus?
The precise role of bilirubin in the development of kernicterus is not completely understood. If the serum unconjugated bilirubin level exceeds the binding capacity of albumin, unbound lipid-soluble bilirubin crosses the blood-brain barrier.