Pathological Jaundice
Jaundice is considered pathological when it deviates from the expected physiological course, posing a risk of bilirubin-induced neurological dysfunction (BIND) or kernicterus.
1. Diagnostic Criteria (Red Flags)
- Timing: Clinical jaundice appearing in the first 24 hours of life.
- Rate of Rise: Bilirubin increasing by > 5 mg/dL/day or > 0.5 mg/dL/hour.
- Severity: Total Serum Bilirubin (TSB) exceeding the 95th percentile on the Bhutani nomogram.
- Persistence: Jaundice lasting > 2 weeks in term infants or > 3 weeks in preterm infants.
- Conjugated Hyperbilirubinemia: Direct bilirubin > 1 mg/dL or > 20% of the total bilirubin (suggests cholestasis).
2. Common Pathological Causes
| Etiology Category | Examples |
|---|---|
| Hemolytic | Rh/ABO incompatibility, G6PD deficiency, Spherocytosis. |
| Non-Hemolytic | Extravascular blood (cephalhematoma), polycythemia, and sepsis. |
| Metabolic/Other | Hypothyroidism, Galactosemia, Breast milk jaundice. |
NEET PG Hint: Always differentiate between Breastfeeding jaundice (early, due to lack of intake) and Breast milk jaundice (late, due to inhibitory factors in milk). Regarding pathological jaundice, always look for reticulocytosis and a positive Coombs test to confirm immune-mediated hemolysis.