Jaundice of the Newborn

the appearance of yellow coloring of the skin and mucous membranes in infants during the first days of life, as a result of a disturbance of bilirubin metabolism.

In healthy infants, physiological jaundice of the newborn arises because of immaturity of the liver’s enzyme systems. Genetically caused (hereditary) enzymopathies, such as transitory familial hyperbilirubinemia, are also found. Jaun-dice of the newborn may appear because of intensified decomposition of erythrocytes: congenital (hereditary) hemolytic jaundice of the newborn. This occurs as the result of a change in the erythrocytes (microspherocytosis), which become more readily subject to destruction (the Minkovskii Chauffard syndrome, named for physiologist O. Minkovskii and the French physician A. Chauffard, who described this pathology in 1900). There are also jaundices that occur with massive hemorrhage at parturition (such as cephalohematoma and retroperitoneal hematoma), during acute and chronic infections of bacterial or viral origin, when there is a congenital deficiency of glucose-6-phosphate dehydrogenase, which participates in bilirubin metabolism. Hemolytic disease of the newborn, which arises when there is an incompatibility between the blood of the mother and that of the child, also causes jaundice in infants. Jaundice of the newborn may be caused by the mechanical arrest of bile (for example, congenital atresia of bile-excreting pathways or tumors of the liver and pancreas) or by affection of the parenchyma of the liver (in connection with diseases such as hepatitis, cytomegaly, sepsis, syphilis, and toxoplasmosis). Treatment is applied according to the cause. Physiological jaundice of the newborn requires no treatment.

REFERENCES

Tabolin, V. A. Bilirubinovyi obrnen i zheltukhi novorozhdennykh. Moscow, 1967.
Grigler, J. F., and V. A. Najjar. “Congenital Familial Nonhemolytic Jaundice with Kernicterus.” Pediatrics, 1952, vol. 10, no. 2. pp. 169–80.

M. IA. STUDENIKIN and R. N. RYLEEVA

jaundice of the newborn

jaundice

[jawn´dis] yellowness of skin, sclerae, mucous membranes, and excretions due to hyperbilirubinemia and deposition of pigments" >bile pigments. It is usually first noticeable in the eyes, although it may come on so gradually that it is not immediately noticed by those in daily contact with the jaundiced person. Called also icterus.
Jaundice is not a disease; it is a symptom of a number of different diseases and disorders of the liver and gallbladder and of hemolytic blood disorders. One such disorder is the presence of a gallstone in the common bile duct, which carries bile from the liver to the intestine. This may obstruct the flow of bile, causing it to accumulate and enter the bloodstream. The obstruction of bile flow may cause bile to enter the urine, making it dark in color, and also decrease the bile in the stool, making it light and clay-colored. This condition requires surgery to remove the gallstone before it causes serious liver injury.
The pigment causing jaundice is called bilirubin. It is derived from hemoglobin that is released when erythrocytes are hemolyzed and therefore is constantly being formed and introduced into the blood as worn-out or defective erythrocytes are destroyed by the body. Normally the liver cells absorb the bilirubin and secrete it along with other bile constituents. If the liver is diseased, or if the flow of bile is obstructed, or if destruction of erythrocytes is excessive, the bilirubin accumulates in the blood and eventually will produce jaundice. Determination of the level of bilirubin in the blood is of value in detecting elevated bilirubin levels at the earliest stages before jaundice appears, when liver disease or hemolytic anemia is suspected.Patient Care. Assessment of the patient with jaundice includes observations of the degree and location of yellowing, noting the color of urine and stools, and the presence of itching. Since jaundice can be accompanied by severe itching, frequent skin care is important to preserve skin integrity. Tepid sponge baths can help reduce discomfort and promote rest.
Patients with severe jaundice are at risk for encephalopathic changes that produce confusion, impaired mentation, and altered levels of consciousness. The potential for injury is increased and demands vigilance and safety measures to protect the patient.

Jaundice may be attributable to prehepatic (A), hepatic (B), or posthepatic (C) causes. From Damjanov, 2000.acholuric jaundice jaundice without bilirubinemia, associated with elevated unconjugated bilirubin that is not excreted by the kidney. Familial acholuric jaundice is another name for the hereditary form of hemolytic jaundice" >hemolytic jaundice.breast milk jaundice elevated unconjugated bilirubin in some breast-fed infants due to the presence of an abnormal pregnane that inhibits glucuronyl transferase conjugating activity.cholestatic jaundice that resulting from abnormality of bile flow in the liver.familial nonhemolytic jaundice Gilbert disease.hematogenous jaundice hemolytic jaundice.hemolytic jaundice see hemolytic jaundice.hepatocellular jaundice jaundice caused by injury to or disease of the liver cells.leptospiral jaundice Weil's syndrome.neonatal jaundice (jaundice of the newborn) icterus neonatorum.nonhemolytic jaundice that due to an abnor-mality in bilirubin metabolism.obstructive jaundice that due to blockage of the flow of bile.physiologic jaundice mild icterus neonatorum during the first few days after birth.

phys·i·o·log·ic jaun·dice

a form of jaundice observed frequently in newborn infants in the first 1-2 weeks of life. It is caused by several factors, including a comparatively high red blood cell mass at birth compared with that of adults, shorter red blood cell lifespan, transiently impaired conjugation of bilirubin in the liver, and lack of gut flora (which are helpful in intestinal metabolism and excretion of bilirubin); is related to indirect (unconjugated) bilirubinemia that peaks at 2-3 days of age in normal, full-term infants and later with higher levels in preterm infants and is accentuated in breast-fed infants. Synonym(s): icterus neonatorum, jaundice of the newborn, neonatal jaundice