It is my understanding that bilirubin is excreted via the bowel.  You also
need to know if baby had a positive or negative Coomb's test, and what were
the values for direct bilirubin.  If the value for direct bili was >1.5
mg/dl different problems need to be checked out. But assuming that was all
done, I nurse and not dress baby in yellow :-)

 Don't forget the article
on Jaundice in the current issue of Contemporary Pediatrics, 16(4), p.
166-183. I'll try to do a flow chart, but I'm not sure if it will work on
e-mail.  And no I don't remember where I got this :-(  It says 236 Ch. 16
Neonatal Hyperbilirubinemia at the top  of the spiral bound page. It is
fig. 16-1.
Sincerely, Pat in SNJ

Clinical jaundice ----------------------------------------
            I                                                    I
           V                                                   V

Bili> 12 mg/ml                                       Bili < 12 mg/dl
 and infant <24 hours old                        and infant > 24 hours old
            I
           V
Coombs' Test-------------------------------------------------------
            I                                                             I
           V                                                            V
Positive Coombs'                      -------------------Negative
Coombs'-----------------
            I                                 I
                               I
           V                                V
                           V
Identify antibody           Direct bili >1.5
              Direct bili <1.5
* Rh                            Consider:
                        I
* ABO                        *Hepatitis
                      V
* Kell, etc.                  * Intrauterine, viral or
    ---------- Hematocrit----
                                    toxoplasmatic inf.
     I                              I
                                 * Biliary Obstruction
    V                            V
                                 * Sepsis
    Normal or low              High
                                 * Galactosemia                 I
(polycythemia)
                                 * Alpha-1-antitrypsin def.             I

                                 *  Cystic fibrosis                     I

                                 * Tyrosinosis                          I

                                 * Cholestosis                          I
                                 * Recd. Hyperal?                       I

       V
                                                RBC morphology

------------------------------------Reticulocyte count----------
                        I                                               I
                        V                                               V
                Abnormal:
Normal:
                *Sphereocytosis                                        * enclosed
hemorrhage
                *Elliptocytosis                            * increased enterohepatic
                        *Stomatocytosis
 circulation
                *ABO incompatibility                                 *  breast milk  :-(
                *Red cell enzyme deficiency                * Lucey-Driscoll syndrome
                *Alpha Thalassemia                         * hypothyroidism
                *Drugs (eg. PCN)                           * Crigler-Najjar syndrome
                *DIC                                       *  Infant of diabetic mother
                                                           * RDS
                                                           * Asphyxia

           * Infection

           * Gilbert's syndrome

* Drugs (eg. Novabiocin)

             ***********************************************
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