Pathophysiology

Physiological jaundice is defined as a temporary inefficient excretion of bilirubin which results in jaundice in full-term infants between the 2nd and 8th day of life. Occurs in ~90% of healthy neonates. Hepatic immaturity and 4 RBC breakdown overloads the neonate's ability to handle the bilirubin which is mainly unconjugated. The bilirubin is rarely >100|jmol/L, though between 2-5 days occasionally can be >200 in a term baby or 250 in a healthy pre-term. Levels much above this need investigation. Reaches a maximum by days 3-6 and usually 5 to normal by day 10. In premature neonates it may take longer to settle. HDN due to blood group incompatibility accounts for ~10% cases of hyperbilirubinaemia and about 75% of those requiring exchange transfusion.

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