Physiological Jaundice in infants appears?

WCL Staff Nurse - 2019

Child Health Nursing (Pediatrics)

Easy

Appeared in: WCL Staff Nurse - 2019

Explanation

Physiological jaundice is a common, transient condition in newborns, which characteristically appears after the first 24 hours of life.
The onset is typically on the 2nd or 3rd day, with bilirubin levels peaking between the 3rd and 5th day.
This entire process of appearance and peaking occurs 'within the first week of birth', making it the most accurate timeframe among the options.
The condition arises from the normal breakdown of fetal red blood cells combined with the transient immaturity of the neonatal liver's ability to conjugate bilirubin.

Option A: Jaundice present at birth or appearing within the first 24 hours is by definition pathological, not physiological. It indicates a more serious underlying condition requiring urgent evaluation.
Option C: While physiological jaundice can sometimes persist into the second week, its initial appearance is in the first week. An onset in the second week is more characteristic of breast milk jaundice.
Option D: This option is incorrect because 'Within first week of birth' is a valid and accurate description that encompasses the typical onset period of physiological jaundice (days 2-7).

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Timing of onset for physiological jaundice in newborns as background academic context rather than a clinical decision trigger.
Nurses are responsible for routinely screening all newborns for jaundice every 8-12 hours by visual inspection and transcutaneous bilirubin (TcB) monitoring.
A key nursing intervention is to promote and support frequent breastfeeding (8-12 times a day) to enhance gut motility and facilitate the excretion of bilirubin through stools.
Nurses must educate parents on the signs of worsening jaundice (e.g., lethargy, poor feeding, yellowing of palms/soles) and the importance of follow-up appointments after discharge.

How to Approach the Question

First, identify the key term in the question: 'physiological jaundice'. This specific type of jaundice has a well-defined onset period.
Recall the fundamental difference between physiological and pathological jaundice, which is the time of appearance. Physiological jaundice always begins after the first 24 hours of life.
Evaluate the given options based on this rule. 'At birth' (within 24 hours) is incorrect and defines pathological jaundice.
'Within first week of birth' correctly includes the typical onset period of day 2 or 3.
'In second week of birth' is too late for the initial onset, although jaundice may persist this long.
By eliminating the incorrect timeframes, you can confidently select the option that best describes the appearance of physiological jaundice.

Concept Tested & Keywords

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E6 Ghai Essential Pediatrics(pp 26-904 of 913) p. 168-170

E6 Text Book Of Pediatric Nursing 3rd Panchali Pal — Part 1 (pp 36-238 of 713) p. 190-192

E6 Nelson Textbook of Pediatrics(2024) — Volume 1 p. 1120-1122