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Conjunctival Icterus – An Important but Neglected Sign of Clinically Relevant Hyperbilirubinemia in Jaundiced Neonates

[ Vol. 13 , Issue. 3 ]

Author(s):

Abeer Azzuqa and Jon F. Watchko*   Pages 169 - 175 ( 7 )

Abstract:


Background: Conjunctival icterus is a largely neglected physical sign that may be helpful in identifying neonates with clinically relevant hyperbilirubinemia by practitioners in the hospital and outpatient clinic or parents at home.

Objective: A recent NICU based study reported that conjunctival icterus is often a sign of significant (TSB ≥ 17 mg/dl) hyperbilirubinemia and TSB levels ≥ 76th-95th percentile on the Bhutani nomogram. In contrast, others report that conjunctival icterus, although frequently present at high TSB levels, may also be detected at lower TSB concentrations; suggesting instead that its absence may help to rule out significant hyperbilirubinemia.

Result and Conclusion: The current review details the nature of conjunctival icterus and presents new data on its clinical occurrence in relation to TSB levels that re-affirm its correlation with elevated TSB concentrations and use to trigger TSB measurement in the jaundiced neonate.

Keywords:

Scleral icterus, conjunctiva, Bhutani nomogram, bilirubin screening, neonatal jaundice, dermal icterus, cutaneous jaundice.

Affiliation:

Division of Newborn Medicine, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, 15213, Pennsylvania, Division of Newborn Medicine, Department of Pediatrics, Magee-Womens Hospital, 300 Halket Street, Pittsburgh, Pennsylvania 15213



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