Question

A neonate has an elevated bilirubin and is slightly jaundiced on day 3 of life. What is the probable reason for these changes?

1. Hemolysis of neonatal red blood cells by the maternal antibodies.
2. Physiological destruction of fetal red blood cells during the extrauterine period.
3. Pathological liver function resulting from hypoxemia during the birthing
process.
4. Delayed meconium excretion resulting in the production of direct bilirubin.

Answer 1

Elevated bilirubin and slight jaundice in a three-day-old neonate are usually due to physiological neonatal jaundice, caused by the normal breakdown of fetal red blood cells and the immature liver enzymes in newborns. Treatment can include phototherapy to help reduce bilirubin levels.

Step-by-step explanation:

A neonate with an elevated bilirubin level and slight jaundice on day 3 of life is most likely experiencing physiological jaundice, which is common and usually harmless. This condition, referred to as physiological neonatal jaundice, happens due to the physiological destruction of fetal red blood cells and a not yet fully matured hepatic system. Newborns process bilirubin less effectively because their liver enzyme (UDP glucuronyl transferase) isn't fully functional. Consequently, excess unconjugated bilirubin builds up, leading to hyperbilirubinemia and jaundice. Other causes, such as hemolysis of neonatal red blood cells by maternal antibodies, pathological liver function, or delayed meconium excretion, typically manifest differently or have additional symptoms and are less likely in an otherwise healthy newborn. Phototherapy, which uses UV light to break down bilirubin, is an effective treatment for high levels of bilirubin to prevent the risk of kernicterus, a type of brain damage that can result from severe jaundice.