📊 Neonatal Jaundice
• Physiologic: after 24h, rises <5 mg/dL/day, resolves by week 1-2
• Pathologic: first 24h, rapid rise, conjugated >2 or >20% of total
• Kernicterus risk: unconjugated bilirubin >20-25 mg/dL
• AAP hour-specific nomogram guides phototherapy/exchange
⚠️ Unconjugated (Indirect) Hyperbilirubinemia
• Hemolysis: ABO/Rh incompatibility, G6PD, spherocytosis
• Breastfeeding jaundice: inadequate intake (first week)
• Breast milk jaundice: after day 7, persists weeks, benign
• Crigler-Najjar, Gilbert syndromes: rare genetic disorders
⚠️ Conjugated (Direct) Hyperbilirubinemia – ALWAYS PATHOLOGIC
• Conjugated >2 mg/dL or >20% of total = needs workup
• Biliary atresia: most common cause of neonatal cholestasis; acholic stools, hepatomegaly; Kasai portoenterostomy if <60 days
• TORCH infections: CMV, toxo, rubella; IUGR, hepatosplenomegaly
• Idiopathic neonatal hepatitis, metabolic (galactosemia, tyrosinemia)
🩺 Older Children
• Viral hepatitis (HAV, HBV, HCV): elevated transaminases
• Autoimmune hepatitis: autoantibodies, hypergammaglobulinemia
• Wilson disease: Kayser-Fleischer rings, neuropsychiatric
• Drug-induced: acetaminophen, isoniazid, valproate, TPN
📌 Decision strategy: Conjugated hyperbilirubinemia always pathologic. Biliary atresia is surgical emergency (Kasai before 60 days). Unconjugated: distinguish hemolysis vs breastfeeding vs breast milk.