All of the following are causes of Neonatal Jaundice, except?

HPSSC Staff Nurse - 2021

Child Health Nursing (Pediatrics)

Medium

Appeared in: HPSSC Staff Nurse - 2021

Explanation

Sickle cell anemia does not typically cause jaundice in the neonatal period (first 28 days).
Newborns have high levels of Fetal Hemoglobin (HbF), which has a protective effect and does not sickle.
The switch from protective HbF to problematic Sickle Hemoglobin (HbS) occurs gradually, with symptoms of sickle cell disease usually appearing after 4-6 months of age.
Therefore, significant hemolysis and resulting jaundice from sickle cell disease are not features of the newborn period.

Option B: Certain forms of thalassemia, specifically alpha-thalassemia major (hydrops fetalis or HbH disease), cause severe hemolysis and anemia starting from birth, making it a recognized cause of neonatal jaundice.
Option C: G6PD deficiency is a common enzyme defect that makes red blood cells fragile. In newborns, it can lead to acute hemolytic anemia and significant hyperbilirubinemia, often triggered by oxidative stress.
Option D: Rh incompatibility is a classic and severe cause of neonatal jaundice. It leads to Hemolytic Disease of the Fetus and Newborn (HDFN), where maternal antibodies destroy fetal red blood cells, causing rapid and severe hyperbilirubinemia.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Etiology of Neonatal Jaundice as background academic context rather than a clinical decision trigger.
A nurse must be aware that jaundice appearing in the first 24 hours of life is always considered pathologic and requires immediate investigation for causes like Rh incompatibility or G6PD deficiency.
Understanding the delayed onset of sickle cell disease is crucial for patient education. Parents of newborns who screen positive for sickle cell disease need to be counseled that symptoms will not appear immediately but require vigilant monitoring as the infant grows.
What if? If a newborn presents with severe jaundice, anemia, and hepatosplenomegaly, and the direct Coombs test is negative (ruling out Rh/ABO incompatibility), the nurse should anticipate further workup for non-immune hemolysis, such as G6PD deficiency or a red cell membrane disorder like hereditary spherocytosis.

How to Approach the Question

First, identify the core concept: causes of jaundice in a newborn (neonatal period).
Note the keyword 'except'. This means you are looking for the one option that is NOT a cause of neonatal jaundice.
Evaluate each option based on its pathophysiology in the context of a newborn's physiology.
Recall or deduce that Rh incompatibility and G6PD deficiency are well-known causes of hemolysis and jaundice in newborns.
Consider Thalassemia. While some forms are asymptomatic at birth, severe alpha-thalassemia is a known cause, so the general term 'Thalassemia' can be a cause.
Evaluate Sickle Cell Anemia. Recall the concept of fetal hemoglobin (HbF) and its protective role. Since HbF prevents sickling and is the dominant hemoglobin at birth, the symptoms of sickle cell disease are delayed. This makes it the most likely exception.

Concept Tested & Keywords

Concept Tested: Etiology of Neonatal Jaundice
Stem keywords: Neonatal Jaundice, causes
Lead-in keywords: except
Negative lead-in flag: The question asks for the exception among the given options.

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E6 Nelson Textbook of Pediatrics(2024) — Volume 1 pp. 1130-1132, 1128-1130, 1117-1119