Pediatric emergency medicine trisk 0887 0887
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TABLE 45.1
CAUSES OF UNCONJUGATED HYPERBILIRUBINEMIA
Excess bilirubin production
Intravascular hemolysis
Intrinsic
Glucose-6-phosphate dehydrogenase deficiency, pyruvate kinase
deficiency
Sickle cell disease, thalassemia
Hereditary spherocytosis, hereditary elliptocytosis
Extrinsic
Isoimmunization (ABO incompatibility, Rh disease)
Infection
Hemolytic anemia (autoimmune, microangiopathic, drug induced)
Extravascular hemolysis
Cephalohematoma
Swallowed blood during birth
Concealed hematoma (intracranial, pulmonary, intra-abdominal)
Polycythemia
Hypersplenism
Decreased bilirubin conjugation
Physiologic jaundice
Gilbert syndrome, Crigler–Najjar syndrome, Lucey–Driscoll syndrome
Galactosemia
Endocrine disorders (congenital hypothyroidism, infant of a diabetic mother)
Breast milk jaundice
Impaired bilirubin excretion
Breast-feeding jaundice
Bowel obstruction
Infection (sepsis, TORCH)
Toxin mediated
Decreased Bilirubin Conjugation
Incomplete maturation of conjugation enzymes in the newborn infant’s liver is the
most common etiology of mild hyperbilirubinemia, with approximately 60% of
neonates manifesting clinical signs of physiologic jaundice. Physiologic jaundice
