1. Physiological Jaundice
Physiological
jaundices refer to the common, generally harmless jaundice seen in many newborn
in the first to second week of life. Most infants develop visible jaundice or
physiological jaundice due to elevation of unconjugated bilirubin concentration
during their first week. For term infants, this jaundice can last for about 10
days with a rapid rise of serum bilirubin up to 204μmol/l (12mg/dl) while for
preterm infant, it can last for about 2 weeks with a rapid rise of serum
bilirubin up to 255μmol/l (15mg/dl). Cause of physiological jaundice includes:
jaundices refer to the common, generally harmless jaundice seen in many newborn
in the first to second week of life. Most infants develop visible jaundice or
physiological jaundice due to elevation of unconjugated bilirubin concentration
during their first week. For term infants, this jaundice can last for about 10
days with a rapid rise of serum bilirubin up to 204μmol/l (12mg/dl) while for
preterm infant, it can last for about 2 weeks with a rapid rise of serum
bilirubin up to 255μmol/l (15mg/dl). Cause of physiological jaundice includes:
i.
Relatively low activity of the enzyme glucuronosyltransferase which
normally converts unconjugated bilirubin to conjugated bilirubin that can be excreted
into the gastro-intestinal tract.
Relatively low activity of the enzyme glucuronosyltransferase which
normally converts unconjugated bilirubin to conjugated bilirubin that can be excreted
into the gastro-intestinal tract.
ii.
Shorter life span of fetal red blood cells, being approximately 80-90
days in a full term infant, compared to 100-120 days in adult.
Shorter life span of fetal red blood cells, being approximately 80-90
days in a full term infant, compared to 100-120 days in adult.
iii.
Relatively low conversion of bilirubin to urobilinogen by the intestinal
flora, resulting in relatively high absorption of bilirubin back into the
circulation (McDonagh, 2007).
Relatively low conversion of bilirubin to urobilinogen by the intestinal
flora, resulting in relatively high absorption of bilirubin back into the
circulation (McDonagh, 2007).
2. Breast Milk Jaundice
This
is also known as prolonged jaundice and it occurs later in the newborn period,
with the bilirubin level usually peaking in the sixth to fourteenth day (6-14)
of life. Reasons for this are:
is also known as prolonged jaundice and it occurs later in the newborn period,
with the bilirubin level usually peaking in the sixth to fourteenth day (6-14)
of life. Reasons for this are:
i.
First, it has been suggested that billirubin uptake in the gut
(entero-hepatic circulation) is increased in breast fed babies, possibly at the
result of increased levels of epidermal growth factors (EGF) in breast milk.
Breast milk also contain glucoronidase which will increase deconjugation and
entero-hepatic recirculation of bilirubin.
First, it has been suggested that billirubin uptake in the gut
(entero-hepatic circulation) is increased in breast fed babies, possibly at the
result of increased levels of epidermal growth factors (EGF) in breast milk.
Breast milk also contain glucoronidase which will increase deconjugation and
entero-hepatic recirculation of bilirubin.
ii.
Second, the breast milk of some women contains a metabolite of
progesterone called 3-alpha-20-beta pregnanediol. This substance inhibits the
action of the enzyme uridine diphospoglucuronic acid (UDPGA) glucuronyl
transferase responsible for conjugation and subsequent excretion of bilirubin.
Second, the breast milk of some women contains a metabolite of
progesterone called 3-alpha-20-beta pregnanediol. This substance inhibits the
action of the enzyme uridine diphospoglucuronic acid (UDPGA) glucuronyl
transferase responsible for conjugation and subsequent excretion of bilirubin.
iii.
Third, an enzyme in breast milk called lipoprotein lipase produce increased
concentration of nonesterified free fatty acids that inhibit hepatic glucuronyl
transferase, which again leads to decrease conjugation and subsequent excretion
of bilirubin (Kamral, Ozkan and Duman, 2009).
Third, an enzyme in breast milk called lipoprotein lipase produce increased
concentration of nonesterified free fatty acids that inhibit hepatic glucuronyl
transferase, which again leads to decrease conjugation and subsequent excretion
of bilirubin (Kamral, Ozkan and Duman, 2009).
