Types of Jaundice in Pediatrics | Causes, Symptoms & Management

 

Types of Jaundice in Pediatrics

Jaundice in children refers to the yellowish discoloration of the skin, sclera, and mucous membranes due to increased bilirubin levels. It is very common in newborns but can also occur in older children. Below are the main types:

1. Physiological Jaundice

• Cause: Immature liver enzymes leading to slow bilirubin conjugation.
• Onset: Appears after 24 hours, peaks at day 3–5, and resolves within 1–2 weeks.
• Features: Mild, self-limiting, no disease.
• Management: Monitoring only, usually no treatment.

2. Pathological Jaundice

This occurs when bilirubin rises excessively or too early. It is always abnormal.

• Causes:
  • Hemolytic: ABO or Rh incompatibility, G6PD deficiency, spherocytosis.
  • Infections: Neonatal sepsis, TORCH infections.
  • Metabolic/Liver disease: Crigler–Najjar syndrome, biliary atresia, galactosemia.
• Features: Appears within 24 hours, bilirubin rises >5 mg/dL/day, lasts >2 weeks.
• Risk: Can lead to kernicterus if untreated.

3. Breastfeeding-related Jaundice

• Breastfeeding Jaundice: Due to insufficient milk intake causing dehydration and increased bilirubin reabsorption (appears in the first week).
• Breast Milk Jaundice: Due to substances in breast milk that slow bilirubin conjugation (appears after the 1st week, may last up to 12 weeks).
• Management: Encourage breastfeeding; temporary interruption only if bilirubin is very high.

4. Conjugated (Cholestatic) Jaundice

• Cause: Impaired excretion of conjugated bilirubin.
• Onset: Always pathological.
• Causes: Biliary atresia, neonatal hepatitis, metabolic disorders.
• Features: Dark urine, pale stools, hepatomegaly, persistent jaundice >2 weeks.
• Management: Requires urgent referral (e.g., surgery for biliary atresia).

5. Hemolytic Jaundice (Older Children)

• Cause: Excessive destruction of red blood cells.
• Causes: Sickle cell disease, G6PD deficiency, malaria.
• Features: Rapid rise in unconjugated bilirubin, anemia, splenomegaly.

Summary Table

Type	Onset	Cause	Key Features	Management
Physiological	After 24 hrs (day 2–5)	Immature liver enzymes	Mild, self-limiting	Monitor only
Pathological	Within 24 hrs or prolonged	Hemolysis, infection, metabolic disease	High/early bilirubin, kernicterus risk	Investigate & treat cause
Breastfeeding-related	1st week or after 1 week	Low milk intake or breast milk factors	Prolonged jaundice	Encourage breastfeeding
Conjugated (Cholestatic)	Anytime (pathological)	Biliary atresia, hepatitis, metabolic issues	Dark urine, pale stools, hepatomegaly	Urgent referral
Hemolytic (Children)	Older infants/children	Sickle cell, G6PD, malaria	Anemia, splenomegaly	Treat underlying cause