Neonatal jaundice is a condition seen in 60% of term and 80% of preterm newborns, marked by high levels of bilirubin in the blood which causes yellowing of the skin and whites of the eyes. It occurs due to increased bilirubin production from the breakdown of red blood cells combined with the immature liver's reduced ability to eliminate bilirubin in newborns. Jaundice is classified as physiological or pathological based on bilirubin levels and timing of onset, and treatment involves phototherapy or exchange transfusion to reduce bilirubin levels if they become too high.
Neonatal jaundice is a condition seen in 60% of term and 80% of preterm newborns, marked by high levels of bilirubin in the blood which causes yellowing of the skin and whites of the eyes. It occurs due to increased bilirubin production from the breakdown of red blood cells combined with the immature liver's reduced ability to eliminate bilirubin in newborns. Jaundice is classified as physiological or pathological based on bilirubin levels and timing of onset, and treatment involves phototherapy or exchange transfusion to reduce bilirubin levels if they become too high.
Neonatal jaundice is a condition seen in 60% of term and 80% of preterm newborns, marked by high levels of bilirubin in the blood which causes yellowing of the skin and whites of the eyes. It occurs due to increased bilirubin production from the breakdown of red blood cells combined with the immature liver's reduced ability to eliminate bilirubin in newborns. Jaundice is classified as physiological or pathological based on bilirubin levels and timing of onset, and treatment involves phototherapy or exchange transfusion to reduce bilirubin levels if they become too high.
Neonatal jaundice is a condition seen in 60% of term and 80% of preterm newborns, marked by high levels of bilirubin in the blood which causes yellowing of the skin and whites of the eyes. It occurs due to increased bilirubin production from the breakdown of red blood cells combined with the immature liver's reduced ability to eliminate bilirubin in newborns. Jaundice is classified as physiological or pathological based on bilirubin levels and timing of onset, and treatment involves phototherapy or exchange transfusion to reduce bilirubin levels if they become too high.
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NEONATAL
JAUNDICE DR.K.L.CHAITANYA ASST.PROFESSOR PAEDIATRICS What is the Neonatal Jaundice? Neonatal Jaundice(also called Newborn jaundice) is a condition marked by high levels of bilirubin in the blood.
The increased bilirubin
cause the infant's skin and whites of the eyes (sclera) to look yellow. N J
- Neonatal Jaundice 3
Visible form of bilirubinemia
› Adult sclera >2mg / dl › Newborn skin >5 mg / dl Occurs in 60% of term and 80% of preterm neonates However, significant jaundice occurs in 6% of term babies
Teaching Aids: NNF
Special characteristic in neonates
• 1.More billirubin produced
• Much more Hemolysis • The life-length of hemolysis(70~80) Special characteristic in neonates
• 2.The low capability of albumin on
unconjugated billirubin transportation • acid intoxication • Less albumin in neonates Special characteristic in neonates
• 3.The low capability of heptatocyte
• Less Y protein and Z protein • The primary development of Hepato-enzyme system • Easy-broken hepato-enzyme system • After-born, the blood glucose level is very low. Special characteristic in neonates
• 4.High workload of the hepato-enteric
circulation • Less bacterial • Low enzymatic activity in intestine • High level of billirubin in meconium A little exam Increased rbc’s
Shortened rbc lifespan
Immature hepatic uptake & conjugation
Increased enterohepatic Circulation Grading of extent of jaundice 2 N J
- Clinical assessment of jaundice 1 1
Area of body Bilirubin levels
mg/dl Face 4-8 Upper trunk 5-12 Lower trunk & thighs 8-16 Arms and lower legs 11-18 Palms & soles > 15
Teaching Aids: NNF
N J
- Physiological jaundice 1 2 Characteristics Appears after 24 hours Maximum intensity by 4th-5th day in term & 7th day in preterm Serum level less than 15 mg / dl Clinically not detectable after 14 days Disappears without any treatment Note: Baby should, however, be watched for worsening of jaundice
Teaching Aids: NNF
N J
- Pathological jaundice 1 3
Appears within 24 hours of age
Increase of bilirubin > 5 mg / dl / day Serum bilirubin > 15 mg / dl Jaundice persisting after 14 days Stool clay / white colored and urine staining clothes yellow Direct bilirubin> 2 mg / dl
Teaching Aids: NNF
N J Causes of jaundice -
1 Appearing within 24 hours of age
4 Hemolytic disease of NB : Rh, ABO Infections: TORCH, malaria, bacterial G6PD deficiency
Physiological Blood group incompatibility G6PD deficiency Bruising and cephalhaematoma Intrauterine and postnatal infections Breast milk jaundice
Teaching Aids: NNF
N J
- Approach to jaundiced baby o birth weight 1 7 o gestation and postnatal age o Assess clinical condition (well or ill) physiological or pathological o Look for evidence of kernicterus* in deeply jaundiced NB o *Lethargy and poor feeding, poor or absent Moro's, opisthotonus or convulsions
Teaching Aids: NNF
N J
- Workup 1 8 Maternal & perinatal history Physical examination Laboratory tests (must in all)* › Total & direct bilirubin* › Blood group and Rh for mother and baby* › Hematocrit, retic count and peripheral smear* › Sepsis screen › Liver and thyroid function › TORCH titers, liver scan when conjugated hyperbilirubinemia
Teaching Aids: NNF
N J
- Management 2 1
Rationale: reduce level of serum bilirubin and
prevent bilirubin toxicity Prevention of hyperbilirubinemia: early feeds, adequate hydration Reduction of bilirubin levels: phototherapy, exchange transfusion, drugs
Teaching Aids: NNF
N J
- Principle of phototherapy 2 2
Native bilirubin Photo isomers of bilirubin
450-460nm of light Insoluble Soluble
Teaching Aids: NNF
N J
- Phototherapy equipment 2 4
White light tubes 6-8*/ 4 blue light tubes
Cradle or incubator Eye shades
*May use 150 W halogen bulb
Teaching Aids: NNF
N J
- Phototherapy 2 5
Technique Perform hand wash Place baby naked in cradle or incubator Fix eye shades Keep baby at least 45 cm from lights, if using closer monitor temperature of baby Start phototherapy
Teaching Aids: NNF
N J
- Phototherapy 2 6
Frequent extra breast feeding every 2 hourly
Turn baby after each feed Temperature record 2 to 4 hourly Weight record- daily Monitor urine frequency Monitor bilirubin level
Teaching Aids: NNF
NJ - Key point in the practical execution 27 of phototherapy 1-The infant should be naked except for diaper , eye to be covered 2- distance between the skin and light source . 3-when used spotlight , the infant is placed in centre . 4- routinely add 10-15% extra fluid . 5- timing of follow -up S.B testing must be individualized. NJ - 28 N J
- Side effects of phototherapy 2 9
Increased insensible water loss
Loose stools Skin rash Bronze baby syndrome Hyperthermia Upsets maternal baby interaction May result in hypocalcemia
Teaching Aids: NNF
N J Choice of blood for exchange - blood transfusion 3 0 ABO incompatibility › Use O blood of same Rh type, ideal O cells suspended in AB plasma Rh isoimmunization › Emergency 0 -ve blood Ideal 0 -ve suspended in AB plasma or baby's blood group but Rh -ve Other situations › Baby's blood group
increases conjugation Metalloporphyrins- tin&zinc-inhibits heme oxygenase IVIG- inhibits heamolysis Oral agar agar &cholestyramine- decreases entero hepatic circulation Albumin infusions-increases bilirubin binding Kernicterus Kernicterus is damage to the brain centers of infants caused by increased levels of unconjugated-indirect bilirubin which is free (not bound to albumin). N J
Suspect High colored urine White or clay colored stool Caution Always refer to hospital for investigations so that biliary atresia or metabolic disorders can be diagnosed and managed early
