Causes of Neonatal Hyperbilirubinemia
Mechanism | Causes |
|---|---|
Increased enterohepatic circulation | Human milk jaundice Breastfeeding (chestfeeding) jaundice Drug-induced paralytic ileus (magnesium sulfate or morphine) Hypoperistalsis Intestinal atresia or stenosis, including annular pancreas Meconium ileus or meconium plug syndrome Swallowed blood |
Overproduction | Breakdown of extravascular blood (eg, hematomas; petechiae; pulmonary, cerebral, or occult hemorrhage) Polycythemia due to maternofetal or fetofetal transfusion or delayed umbilical cord clamping |
Overproduction due to hemolytic anemia | Certain medications and agents in neonates with G6PD deficiency (eg, acetaminophen, alcohol, antimalarials, aspirin, bupivacaine, corticosteroids, diazepam, nitrofurantoin, oxytocin, penicillin, phenothiazine, sulfonamides) Maternofetal blood group incompatibility (eg, Rh, ABO) Red blood cell enzyme deficiencies (eg, of G6PD or pyruvate kinase) |
Undersecretion due to biliary obstruction | Alpha-1 antitrypsin deficiency* Choledochal cyst* Cystic fibrosis* (inspissated bile) Dubin-Johnson syndrome and Rotor syndrome* Tumor or band* (extrinsic obstruction) |
Undersecretion due to metabolic-endocrine conditions | Crigler-Najjar syndrome (familial nonhemolytic jaundice types 1 and 2) Medications and hormones Hypermethioninemia Hypopituitarism and anencephaly Lucey-Driscoll syndrome Tyrosinosis |
Mixed overproduction and undersecretion | Asphyxia Intrauterine infections Severe hemolytic disease of the neonate TORCH infections |
* Jaundice may also occur outside the neonatal period. | |
G6PD = glucose-6-phosphate dehydrogenase; TORCH = toxoplasmosis, other pathogens, rubella, cytomegalovirus, and herpes simplex. | |
Adapted from Poland RL, Ostrea EM Jr: Neonatal hyperbilirubinemia. In Care of the High-Risk Neonate, ed. 3, edited by MH Klaus and AA Fanaroff. Philadelphia, WB Saunders Company, 1986. | |