Asstprofessor paediatrics What is the Neonatal Jaundice Neonatal Jaundicealso called Newborn jaundice is a condition marked by high levels of bilirubin in the blood The increased bilirubin cause the infants skin and whites of the eyes sclera to look yellow ID: 1044722
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1. NEONATAL JAUNDICEDr.K.L.ChaitanyaAsst.professorpaediatrics
2. 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.
3. Neonatal JaundiceVisible form of bilirubinemia Adult sclera >2mg / dlNewborn skin >5 mg / dlOccurs in 60% of term and 80% of preterm neonatesHowever, significant jaundice occurs in 6 % of term babies Teaching Aids: NNFNJ - 3
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5. Special characteristic in neonates1.More billirubin producedMuch more HemolysisThe life-length of hemolysis(70~80)
6. Special characteristic in neonates2.The low capability of albumin on unconjugated billirubin transportationacid intoxicationLess albumin in neonates
7. Special characteristic in neonates3.The low capability of heptatocyteLess Y protein and Z protein The primary development of Hepato-enzyme systemEasy-broken hepato-enzyme systemAfter-born, the blood glucose level is very low.
8. Special characteristic in neonates4.High workload of the hepato-enteric circulationLess bacterialLow enzymatic activity in intestineHigh level of billirubin in meconium
9. A little examIncreased rbc’sShortened rbc lifespanImmature hepatic uptake & conjugationIncreased enterohepaticCirculation
10. Grading of extent of jaundice 2
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13. Pathological jaundiceAppears within 24 hours of ageIncrease of bilirubin > 5 mg / dl / daySerum bilirubin > 15 mg / dlJaundice persisting after 14 daysStool clay / white colored and urine staining clothes yellowDirect bilirubin> 2 mg / dlTeaching Aids: NNFNJ - 13
14. Causes of jaundiceAppearing within 24 hours of ageHemolytic disease of NB : Rh, ABOInfections: TORCH, malaria, bacterialG6PD deficiencyAppearing between 24-72 hours of lifePhysiologicalSepsisPolycythemiaConcealed hemorrhageIntraventricular hemorrhageIncreased entero-hepatic circulationTeaching Aids: NNFNJ - 14
15. Causes of jaundiceAfter 72 hours of ageSepsisCephalhaematomaNeonatal hepatitisExtra-hepatic biliary atresiaBreast milk jaundiceMetabolic disordersTeaching Aids: NNFNJ - 15
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21. ManagementRationale: reduce level of serum bilirubin and prevent bilirubin toxicityPrevention of hyperbilirubinemia: early feeds, adequate hydrationReduction of bilirubin levels: phototherapy, exchange transfusion, drugsTeaching Aids: NNFNJ - 21
22. Principle of phototherapyNative bilirubin Photo isomers of bilirubin Insoluble SolubleTeaching Aids: NNFNJ - 22450-460nmof light
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24. Phototherapy equipmentWhite light tubes 6-8*/ 4 blue light tubesCradle or incubatorEye shades*May use 150 W halogen bulbTeaching Aids: NNFNJ - 24
25. PhototherapyTechniquePerform hand washPlace baby naked in cradle or incubatorFix eye shadesKeep baby at least 45 cm from lights, if using closer monitor temperature of babyStart phototherapyTeaching Aids: NNFNJ - 25
26. PhototherapyFrequent extra breast feeding every 2 hourlyTurn baby after each feedTemperature record 2 to 4 hourlyWeight record- dailyMonitor urine frequencyMonitor bilirubin levelTeaching Aids: NNFNJ - 26
27. NJ - 27Key point in the practical execution of phototherapy1-The infant should be naked except for diaper , eye to be covered2- 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.
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31. DRUGSPhenobarbitone- increases y&z ligandin receptors-induces liver enzymes-increases conjugationMetalloporphyrins- tin&zinc-inhibits heme oxygenaseIVIG- inhibits heamolysisOral agar agar &cholestyramine- decreases entero hepatic circulationAlbumin infusions-increases bilirubin binding
32. KernicterusKernicterus is damage to the brain centers of infants caused by increased levels of unconjugated-indirect bilirubin which is free (not bound to albumin).
33. Prolonged indirect jaundiceCausesCrigler Najjar syndromeBreast milk jaundiceHypothyroidismPyloric stenosisOngoing hemolysis, malariaTeaching Aids: NNFNJ - 33
34. Conjugated hyperbilirubinemia SuspectHigh colored urineWhite or clay colored stool CautionAlways refer to hospital for investigations so that biliary atresia or metabolic disorders can be diagnosed and managed earlyTeaching Aids: NNFNJ - 34
35. Conjugated hyperbilirubinemia
36. THANK YOU