2. Neonatal Jaundice
• Learning Objectives:
• Define hyperbilirubinemia.
• Differentiate between physiological and
pathological jaundice.
• Causes of hyperbilirubinemia.
• Discuss the pathophysiology of hyperbilirubinemia.
• Describe the most dangerous complication of
hyperbilirubinemia.
• therapeutic management.
• Design plan of care for baby has hyperbilirubinemia.
3. 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.
5. 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
• 6-10% require phototherapy/ other
therapeutic options.
6. Bilirubin metabolism
Hb → globin + haem
1g Hb = 34mg bilirubin
Non – heme source
1 mg / kg
Bilirubin
glucuronidase
Bilirubin
Bilirubin
Ligandin
(Y - acceptor)
Bil glucuronide
Intestine
Bil
glucuronide
Stercobilin
bacteria
β glucuronidase
8. Clinical assessment of jaundice
(Kramer’s staging)
Area of body Bilirubin levels
mg/dl (*17=umol)
Face Zone-1: 4-6
Upper trunk Zone-2: 6-8
Lower trunk & thighs 8-16
Arms and lower legs Zone-3: 8-12
Palms & soles Zone-4 :12-14
Zone-5 :>15
9. Physiological jaundice
Characteristics
• Appears after 24-72 hours
• Maximum intensity by 3th-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.
11. 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
12. Causes of jaundice
Appearing within 24 hours of age
• Hemolytic disease of NB : Rh, ABO
• Infections: TORCH, malaria, bacterial
• G6PD deficiency
13. Causes of jaundice
Appearing between 24-72 hours of life
• Physiological
• Sepsis
• Polycythemia
• Intraventricular hemorrhage
• Increased entero-hepatic circulation
14. Causes of jaundice
After 72 hours of age
• Sepsis
• Cephalhaematoma
• Neonatal hepatitis
• Extra-hepatic biliary atresia
• Breast milk jaundice
• Metabolic disorders (G6PD).
15. Breast feeding jaundice
• In exclusively breast feed infants
• Appears at 24-48 hrs of age
• Peaks by 5-15 days
• Disappears by 3rd week
• Its related to inadequate B.F
• T/t:Proper & adequate B.F
16. Breast milk jaundice
• In 2-4 % EBF babies
• SBr>10mg/dl beyond 3rd-4th week
• Should be differentiated from Hemolytic
jaundice, hypothyroidism, G6PD def
• T/t: Some babies may require PT
Continue breast feeding
Usually declines over a period of time
17. 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
19. Therapeutic Management
• Purposes: reduce level of serum bilirubin and
prevent bilirubin toxicity
• Prevention of hyperbilirubinemia: early feeds,
adequate hydration
• Reduction of bilirubin levels: phototherapy,
exchange transfusion,
• Drugs Use of Phenobarbital promote liver
enzymes and protein synthesis.
22. Nursing considerations of Hyperbilirubinemia
• Assessment:
observing for evidence of
jaundice at regular intervals.
Jaundice is common in
the first week of life and
may be missed in dark skinned
babies
Blanching the tip
of the nose
23. 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
*Lethargy and poor feeding, poor or absent Moro's, or
convulsions
24. The goals of planning
• Infant will receive appropriate therapy if
needed to reduce serum bilirubin levels.
o Infant will experience no complications from
therapy.
o Family will receive emotional support.
