Jaundice at birth or within 20 hours of birth is commonly due to?

RUHS, Jaipur, M.Sc Nursing Entrance Exam-2021

Child Health Nursing (Pediatrics)

Easy

Appeared in: RUHS, Jaipur, M.Sc Nursing Entrance Exam-2021

Explanation

Jaundice appearing within the first 24 hours of life is defined as pathological jaundice.
Erythroblastosis fetalis, a type of hemolytic disease of the newborn, is a primary cause of pathological jaundice.
This condition results from maternal antibodies destroying fetal red blood cells, leading to a rapid increase in bilirubin levels immediately after birth.
The key differentiator is the early onset (less than 24 hours), which points away from physiological causes.

Option A: Physiological jaundice is caused by the normal immaturity of the newborn's liver and typically appears after 24 hours of life, usually peaking around day 3 to 5.
Option C: Biliary atresia is a condition where the bile ducts are blocked. It causes cholestatic (direct) jaundice, which typically becomes apparent after 2 weeks of age and is associated with pale stools and dark urine.
Option D: This is a very broad term that encompasses many conditions, including erythroblastosis. However, erythroblastosis fetalis is the most specific and common cause for severe jaundice presenting at birth or within the first day.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Causes of Neonatal Jaundice as background academic context rather than a clinical decision trigger.
Recognizing the timing of jaundice onset is a critical nursing assessment skill. Jaundice within 24 hours is a medical emergency requiring prompt reporting and intervention to prevent kernicterus (brain damage from high bilirubin levels).
Nurses play a key role in educating parents about the signs of worsening jaundice and the importance of follow-up appointments after discharge.
What if? If the jaundiced infant also presented with pale, clay-colored stools and dark urine at 3 weeks of age, the priority concern would shift from hemolysis to biliary atresia, requiring a different diagnostic workup (e.g., direct bilirubin, abdominal ultrasound).

How to Approach the Question

First, identify the key information in the question stem: the symptom is 'jaundice' and the timing is 'at birth or within 20 hours'.
Recognize that the timing of onset is the most critical factor in differentiating types of neonatal jaundice.
Recall the definition of pathological jaundice: any jaundice appearing within the first 24 hours of life.
Evaluate the options based on this timeline. 'Physiological' jaundice occurs after 24 hours. 'Biliary atresia' occurs much later (weeks).
Between 'Erythroblastosis' and 'Congenital hyperbilirubinemia', choose the more specific and common cause for this acute, early presentation. Erythroblastosis (hemolysis) is the classic cause of jaundice at birth.

Concept Tested & Keywords

Concept Tested: Causes of Neonatal Jaundice
Stem keywords: Jaundice, at birth, within 20 hours
Lead-in keywords: commonly due to
Clinical cues: Onset of jaundice within 24 hours of birth is a red flag for a pathological process.

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