Neonatal jaundice, also known as hyperbilirubinemia, refers to high levels of bilirubin in a newborn baby's blood. It is characterized by a yellowing of the skin. The document discusses physiological versus pathological jaundice, causes of high bilirubin levels, methods for assessing jaundice severity, diagnostic workup, and management approaches including phototherapy and exchange transfusion. The goal of treatment is to reduce bilirubin levels and prevent potential brain damage from severe hyperbilirubinemia.
Neonatal jaundice, also known as hyperbilirubinemia, refers to high levels of bilirubin in a newborn baby's blood. It is characterized by a yellowing of the skin. The document discusses physiological versus pathological jaundice, causes of high bilirubin levels, methods for assessing jaundice severity, diagnostic workup, and management approaches including phototherapy and exchange transfusion. The goal of treatment is to reduce bilirubin levels and prevent potential brain damage from severe hyperbilirubinemia.
Neonatal jaundice, also known as hyperbilirubinemia, refers to high levels of bilirubin in a newborn baby's blood. It is characterized by a yellowing of the skin. The document discusses physiological versus pathological jaundice, causes of high bilirubin levels, methods for assessing jaundice severity, diagnostic workup, and management approaches including phototherapy and exchange transfusion. The goal of treatment is to reduce bilirubin levels and prevent potential brain damage from severe hyperbilirubinemia.
Neonatal jaundice, also known as hyperbilirubinemia, refers to high levels of bilirubin in a newborn baby's blood. It is characterized by a yellowing of the skin. The document discusses physiological versus pathological jaundice, causes of high bilirubin levels, methods for assessing jaundice severity, diagnostic workup, and management approaches including phototherapy and exchange transfusion. The goal of treatment is to reduce bilirubin levels and prevent potential brain damage from severe hyperbilirubinemia.
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Neonatal Jaundice
Neonatal Jaundice Learning Objectives: • Define hyperbilirubinemia. • Differentiate between physiological and pathological jaundice. • State causes of hyperbilirubinemia. • Discuss the pathophysiology of hyperbilirubinemia. • Describe the most dangerous complication of hyperbilirubinemia. • List the three elements of therapeutic management. • Design plan of care for baby has hyperbilirubinemia. Neonatal Jaundice (Hyperbilirubinemia)
Definition: Hyperbilirubinemia refers to an
excessive level of accumulated bilirubin in the blood and is characterized by jaundice, a yellowish discoloration of the skin, sclerae, mucous membranes and nails.
Unconjugated bilirubin = Indirect bilirubin.
Conjugated bilirubin = Direct bilirubin. NJ - 3 Neonatal Jaundice Visible form of bilirubinemia – Newborn skin >5 mg / dl Occurs in 60% of term and 80% of preterm neonates However, significant jaundice occurs in 6 % of term babies
Bilirubin glucuronidase Bil Bil glucuronide glucuronide
β glucuronidase
bacteria Bilirubin
Stercobilin
Bilirubin metabolism NJ - 5 Bilirubin Production & Metabolism
NJ - 6 Clinical assessment of jaundice
Area of body Bilirubin levels
mg/dl (*17=umol)
Face 4-8 Upper trunk 5-12 Lower trunk & thighs 8-16 Arms and lower legs 11-18 Palms & soles > 15 NJ - 7 Physiological jaundice 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 jaundice. NJ - 8 Why does physiological jaundice develop?
Increased bilirubin load.
Defective uptake from plasma. Defective conjugation. Decreased excretion. Increased entero-hepatic circulation. NJ - 9 Course of physiological jaundice
15 Bilirubin level mg/dl
10
5 Term Preterm
1 2 3 4 5 6 10 11 12 13 14 Age in Days NJ - 10 Pathological jaundice 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
NJ - 11 Causes of jaundice Appearing within 24 hours of age Hemolytic disease of NB : Rh, ABO Infections: TORCH, malaria, bacterial (sepsis) G6PD deficiency
NJ - 12 Causes of jaundice Appearing between 24-72 hours of life Physiological Sepsis Polycythemia Intraventricular hemorrhage Increased entero-hepatic circulation NJ - 13 Causes of jaundice After 72 hours of age Sepsis /UTI Cephalhaematoma Neonatal hepatitis Extra-hepatic biliary atresia Breast milk jaundice Metabolic disorders (G6PD).
NJ - 14 Risk factors for jaundice JAUNDICE J - jaundice within first 24 hrs of life A - a sibling who was jaundiced as neonate
U - unrecognized hemolysis N – non-optimal sucking/nursing D - deficiency of G6PD I - infection C – cephalhematoma /bruising E - East Asian/North Indian NJ - 15 Approach to jaundiced baby
Ascertain birth weight, gestation and
postnatal age Ask when jaundice was first noticed Assess clinical condition (well or ill) Decide whether jaundice is physiological or pathological Look for evidence of kernicterus* in deeply jaundiced NB
*Lethargyand poor feeding, poor or absent Moro's, or
convulsions
NJ - 16 NJ - 17 Workup
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: NJ - 18 NNF NJ - 19 NJ - 20 NJ - 21 NJ - 22 Management 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(phenobarbitone,IV IG,Metalloporphyrins)
Teaching Aids: NJ - 23 NNF Principle of phototherapy
450-460nm Native bilirubin Photo isomers of bilirubin of light
Insoluble Soluble
Teaching Aids: NJ - 24 NNF Phototherapy equipment
White light tubes 6-8*/ 4 blue light tubes
Cradle or incubator Eye shades
*May use 150 W halogen bulb
Teaching Aids: NJ - 25 NNF Babies under phototherapy
Baby under conventional Baby under triple unit intense
phototherapy phototherapy Phototherapy 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: NJ - 27 NNF Phototherapy 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: NJ - 28 NNF Side effects of phototherapy
Increased insensible water loss
Loose stools Skin rash Bronze baby syndrome Hyperthermia Upsets maternal baby interaction May result in hypocalcemia Trasient porphyrinemia Teaching Aids: NJ - 29 NNF Treatment of Indirect Hyperbilirubinemia: Exchange Transfusion: – Double-volume exchange 2 x blood volume = 2 x 80 cc/kg = 160 cc/kg – Takes about 1-1.5 hours – Exchange at rate of ~5cc/kg/3 min – Volume withdrawn/infused based on weight Maisel’s chart Age in hrs Sr Birth Bilirubin weight < 24 24 – 48 49 – 72 >72 (mg/dl)
<5 All
Phototherapy 5-9 All if hemolysis < 2500g Phototherapy PHOTOTHERAPY 10-14 if hemolysis Investigate if bilirubin > 2500g > 12mg%
NJ - 34 Conjugated hyperbilirubinemia 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
