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miracle · Credits: 1283 My Scrapbook

true regarding physiological jaundice is....
a.occurs due to increase rbc destruction
b. indication to stop breast feeding
c.lasts for 3 weeks
ans is given as b
but shudnt it be a? the table in ghai says decreased rbc survival as a cause

akanksha · Credits: 41247 My Scrapbook My Reading List 14 Books

nelson says,

physiological jaundice is believed to be the result of increased bilirubin production following breakdown of fetal red blood cells combined with transient limitation in the conjugation of bilirubin by the liver.

nelson further says,

Persistent indirect hyperbilirubinemia beyond 2 wks suggests

hemolysis
hereditary glucuronyl transferase deficiency
breast milk jaundice

hypothyroidism, or
intestinal obstruction

ghai also says,

ther is strong association of neonatal jaundice with breast feeding in is seen esp in babies who r exclusively breast fed,n is almost absent in formula fed infants!

also dat,

a few babies who remain on exclusive breast-feeds develop jaundice in the 2nd week of life n continue well into the 3rd month.

morever,ghai mentions,
breast milk as a cause responsible for exaggerating the physiological jaundice,not as a cause itself responsible for phy. jaundice.

i think,choice a wud be most appropriate ans to this question!

pls opine! 8)

pilgrim · Credits: 957 My Scrapbook

hey

cool info aks..
i agree the best answer among the choices is a

cos the othere choices are very wrong

aartisarwal · Credits: 148 My Scrapbook

First of all thanks for your genuine interest and participation .I sincerely appreciate it.

My explanations are based on reference from OP Ghai page 99.
With due regards to the authority of Nelson overriding OP Ghai,
there are a few things I’ll like you to reconsider before we give a final dissent to the answer.

Choice 1:
“Pathogenesis of physiological jaundice in the new born:
Hepatic immaturity:physiological jaundice is due to immaturity of the liver during the first few days of life.activity of the enzyme UDP-glucuronosyl transferase is low in the first few days of life. Bilirubin produced as a result of breakdown of red blood cells at a normal rate cannot be glucuronidated. Unconjugated bilirubin accumulates till it can be cleared by the liver as the enzyme system matures.”

Implied: Physiological jaundice may occur even without increased RBC destruction.

Choice 2:
Physiological jaundice may be exaggerated in the setting of breast milk jaundice. “Temporary interruption of nursing for three to four days helps in lowering bilirubin levels.” In my alma mater, we were taught Serum Bilirubin level > 17 mg% as an indication to stop breast-feeding temporarily and resume after 3-4 days.

Implied: breast milk jaundice and physiological jaundice are not synonymous terms. But physiological jaundice exacerbated by breast milk may respond to stopping the feeds albeit temporarily. Breast-feeding jaundice is another entity.

Choice 3:
Another dictum taught is any jaundice appearing before 24 hours and lasting > 2 weeks is not physiological. It may be prolonged up to a month in premature but the question here is about a metaphorical generalization of physiological jaundice.
Though 90% of the times, jaundice in a newborn is the physiological jaundice, some features may be suggestive of another disease. If the following signs appear, look for other causes-
· Jaundice appearing within first 24 hours of life.
· Jaundice persists even after 14 days of life
· Baby is not feeding well.
· Baby's urine becomes yellow in color
· The stools of the baby are pale or clay colored (almost whitish)
· Baby appears lethargic, irritable

Additional references:
MEDLINE:a service of US LIBRARY OF MEDICINE and National Institute of Health

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In light of this, I chose choice b as the most appropriate.
This is a very basic pediatric question, often repeated in all exams and we shouldn’t get this one wrong.
Kindly review the references from Nelson ,Ghai and the website again and post your opinion.

pilgrim · Credits: 957 My Scrapbook

well well well

great work there arti..
but hey nowhere is it given or practised that in a case of "physiological jaundice"...its mentioned in those many words ..isnt it.. do we have to stop breast feeding....

Its no longer physiological jaundice then.....

we have to go for the best answer among the choices ..among the choices ..i belive it is a) which is the answer..cos its partly correct..whereas b) is not correct..

becos for all practical purposes ..physiological jaundice is seperate from breast milk jaundice..

It will recede on its own without any intervention and if it requires stoppage of breast feeding..it is no longer purely physioloigical jaundice

akanksha · Credits: 41247 My Scrapbook My Reading List 14 Books

aartisarwal · Credits: 148 My Scrapbook

So we have a winner here.

Thanks pilgrim,akansha and miracle for making us wiser.

and Pilgrim,if you dont mind,I prefer my name with a double 'A'.

All the best.

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