41 - Differential diagnosis of Neonatal Jaundice

A. Jaundice consisting of either direct or indirect  bilirubin, that is present at birth or appears with in the first 24 hours of life causes :
*Erythroblastosis fetalis (high direct bilirubin - in infants who were given intrauterine transfusions)
*Concealed hemorrhage
*Sepsis
*Congenital infections like syphilis, CMV, rubella and toxoplasmosis
*Jaundice secondary to extensive eccymosis or blood extravasation may occur during the first day or later, especially in premature infants


B. Jaundice which first appears on the second or third day causes :
*Physiological jaundice
*Familial non-hemolytic icterus (Crigler-Najjar syndrome)
*Early onset breast feeding jaundice

C.Jaundice appearing after the third and within 1 week causes :
*Bacterial sepsis
*Urinary tract infection
*Infections like syphilis, toxoplasmosis, CMV or enterovirus

D. Jaundice first recongnised after the first week of life causes :
*Breast milk jaundice
*Septicemia
*Congenital atresia or paucity of the bile ducts
*Hepatitis
*Galactosemia
*Hypothyroidism
*Cystic fibrosis
*Congenital hemolytic anemia crises related to red cell morphology and enzyme deficiencies


E. Persistant jaundice during the first month of life causes :
*Hyperalimentation associated cholestasis
*Hepatitis
*Cytomegalic inclusion disease
*Syphilis
*Toxoplasmosis
*Familial non-hemolytic icterus
*Congenital atresia of the bile ducts
*Galactosemia
*Inspissated bile syndrome following hemolytic disease of newborn
*Rarely physiologic jaundice may be prolonged for several weeks, as in infants with hypothyroidism or pyloric stenosis.

P.S: Polycythemia may also lead to early jaundice.

40 - Treatment of Vesicoureteral reflux in children

Grade I	Reflux into a non-dilated ureter
Grade II	Reflux into the upper collecting system without dilatation
Grade III	Reflux into dilater ureter and/or blunting of calyceal fornices
Grade IV	Reflux into a grossly dilated ureter
Grade V	Gross dilatation of the ureter, renal pelvis and calyces: Calyces show loss of papillary impression

*TREATMENT RECOMENDATION FOR VUR diagnosed following a UTI :

GRADE	AGE(YRS)	SCARRING	INITIAL TREATMENT	FOLLOW-UP
I-II	Any	-	Antibiotic prophylaxis	-
III-IV	0-5	-	Antibiotic prophylaxis	Surgery
III-IV	6-10	-	U/L: Antibiotic prophylaxis	Surgery
III-IV	6-10	-	B/L: Surgery
V	less than 1	-	Antibiotic prophylaxis	Surgery
V	1-5	No	U/L: Antibiotic prophylaxis	Surgery
V	1-5	No	B/L: Surgery
V	1-5	Yes	Surgery
V	6-0	-	Surgery