Physiologic jaundice

Physiologic jaundice in the newborn, especially premature infimts (enzymes may not be fuUy induced)... 

C) Physiological jaundice due to destruction of fetal red blood mass... 

Maternal oxytocin administration increases the rate of neonatal physiological jaundice in a dose-dependent manner (SEDA-13, 1310) (11). This effect may be due to hemodilution and an increased rate of hemolysis. 

So-called physiological jaundice in infants is attributable to a rise in plasma bilirubin, the conjugated bile pigments being absent. Billing et al. (Bll) found that the maximum increase in bilirubin concentration... 

The physiological jaundice of the newborn rarely produces serum bilirubin values greater than 5mg/dL (85 Xmol/L). Distinguishing this naturally occurring phenomenon from other conditions that produce neonatal hyperbilirubinemia may be difficult, and the chronological course of the hyperbilirubinemia is important. 

Causes of unconjugated hyperbilirubinemia in the neonate are physiological jaundice of the newborn, hemolytic disease, and breast milk hyperbilirubinemia. 

Physiological Jaundice of the Newborn, Babies frequently become jaundiced within a few days of birth, a condition known as physiological jaundice of the newborn. Bilirubin levels reach a peak within 3 to 5 days of birth and remain elevated for less than 2 weeks. Bilirubin is usually less than 5 mg/dL, with 90% unconjugated. Factors contributing to physiological jaundice are (1) an increased bilirubin load in the newborn because the RBCs have a shortened lifespan,... 

H13. Hilderbrand, D. C., Jahim, Z., James, E., and Fahim, M., Ceruloplasmin and alkaline phosphatase levels in cord serum of term, preterm and physiologically jaundiced neonates. Am. ]. Obstet. Gynecol. 118, 950-954 (1974). 

L6. Levi, A. J., Gatmaitan, Z., and Arias, 1. M., Deficiency of hepatic organic anion-binding protein, impaired organic uptake by liver and physiologic jaundice in newborn monkeys. N. Engl. J. Med. 283, 1136-1139 (1970). 

There are two types of jaundice, physiologic and pathologic. Physiologic jaundice is a common condition that can be observed in 80% of pre-term newborns and in 60% of normal newborns. It is a benign condition with increased levels of bilirubin at the end of the first week of life. Patients are active and no signs of sepsis or anemia should be present (Gubernick et al. 2000). 

When red blood cells break down, the resulting components include heme and globin, and bilirubin is contained in the heme moiety (Tenhunen et al., 1968). Upon release, free bilirubin is lipid soluble and must be transported in plasma bound to the protein albumin (Ostrow et al., 1963). The life span of red blood cells in adults is about 120 days, and in newborns is reduced to around 90 days (Borun et al., 1957). This results in a significant amount of bilirubin to be removed, and the newborn liver must develop functional enzymatic capability quickly in order to prevent jaundice. In fact, 10-20% of newborns develop a transient physiological jaundice as the enzymatic ability of the liver develops to conjugate and eliminate bilirubin from the serum. 

Richards et al. (1957), however, could find no correlation between the degree of peroxide hemolysis and the intensity of physiological jaundice in the newborn, and Goldbloom (1960) found normal red cell survival in tocopherol-deficient rats and in a 2-year-old boy with fibrocystic disease of the pancreas and persistently low serum tocopherol levels. 

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