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.