Neonatal Jaundice.

Valmiki Seecheran.Year V MBBS.

Introduction.

• A bilirubin level of more than 5mg/dl manifests clinical jaundice in neonates.

• Cranio-caudal progression.• 50-60% of babies affected in the first week of

life.

Physiological

• Most infants develop visible jaundice due to elevation of unconjugated bilirubin concentration during their first week.

• Phase I.– Term infants – lasts up to 10 days with rapid rise of serum

bilirubin up to (12mg/dL).– Preterm infants – lasts up to two weeks with rapid rise of

serum bilirubin up to (15mg/Dl).• Phase II – bilirubin levels decline to 2mg/Dl for 2 weeks.

– Preterm infants – phase II can last more than 1 month.– Breastfed infants – phase I can last more than 1 month.

Causes.

• Low enzymatic activity of glucruonosyltransferase. (converts unconjugated to conjugated bilirubin).

• Shorter life span of fetal red blood cells. (90days).

• Low conversion of bilirubin to urobilinogen by intestinal flora.

Pathological.

• Clinical jaundice appearing in the 1st 24 hours or greater than 14 days of life.

• Increases in the level of total bilirubin by more than (0.5 mg/dL) per hour or 5 mg/dL per 24 hours.

• Total bilirubin more than (19.5 mg/dL) • Direct bilirubin more than (2.0 mg/dL).

Pathological vs. Physiological.

• Presence of intrauterine growth restriction.• Family history of jaundice and anemia.

(Neonatal or early infant death.)• Maternal drugs (sulphanoamides, anti-

malarials).• Stigma of intrauterine infections– Cataracts, microcephaly, cephalohematomas.

Causes of jaundice.

• Breakdown of fetal hemoglobin.• Immature hepatic metabolic pathways.• In the event if neonatal jaundice is not

alleviated with phototherapy, biliary atresia, progressive familial intrahepatic cholestasis and other pediatric liver diseases should be considered.

Causes of jaundice.

• Unconjugated bilirubin.– Pathologic.

• Hemolytic. – G6PD, spherocytosis, sickle cell, sepsis, ABO.• Non-hemolytic. –Breast milk, UTI, Sepsis.

– Physiological• Conjugated bilirubin.– Hepatic. – Sepsis, Hep A & B, Alpha 1 antitrypsin

deficieny.– Post-hepatic. – Bile duct obstruction.

Causes of jaundice.

• Breast milk jaundice is a biochemical occurrence. Bilirubin levels peaks 6-14days of life.

• Enzymes such as 3 alpha 20 beta pregnanediol and lipoprotein lipase prevents conjugation leading to higher levels of bilirubin in blood.

Clinical assessment.

• Ingram icterometer.– 5 transverse strips of graded yellow lines. – Pressed against the nose and the corresponding

yellow colour of the blanched skin is match and level is assigned.

• Transcutaneous bilirubinometer.– Pressure applied to photoprobe, generates light,

the intensity of the yellow colour in the light is measured and displayed.

Treatment.

• Phototherapy– Discovered in Essex, England by a nurse.– Process of isomerization that changes trans-

bilirubin into water soluble bilirubin isomer.– Blue light more effective at breaking down

bilirubin.– Biliblanket.

• Exchange transfusions.– Indicated for a total serum bilirubin >25mg/Dl.

Complications.

• Kernicterus – chronic bilirubin encephalopathy.– Neurotoxic.– Gray matter of the brain.– Brain damage/death.

• Fever/ Seizures.

Thank you.