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Neonatology Department
      Hadi Clinic
   Neonatal Jaundice : Condition marked by
    high levels of bilirubin in the blood
   Yellowish discoloration of skin & mucous membrane

   Bilirubin level >5mg/dl (85 µmol/L)
   ‘Cephalo – Caudal distribution’

   Normal term neonates : 30% - 50%
1.    Physiological Jaundice
         Appears within 2 – 3 days (>24hrs of age)
         Most common due to immaturity of bilirubin UDGT activity

2.       Pathologigal Jaundice
      Appears within 24hrs
      Common cause : ABO , Rh incompatibility & Sepsis
1.   Unconjugated – Lipid Soluble
        Hemolytic Disease : ABO, Rh incompatibility
        G-6-PD deficiency
        Breast Milk Jaundice
        High level results in Kernicterus

2.   Conjugated – Water Soluble
        Conjugated bilirubin >= 20% total bilirubin
        DR Alfa ABC GoT Conjugated Hyperbilirubinemia due to sepsis
   Blood Group O
   Rh –ve mother
   Previous sibling developed significant
    hyperbilirubinemia
   Infant of diabetic mother (IDM)
   Preterm infants
   For all jaundiced babies : CBC , ABO , RH , TSB , Direct
    Bilirubin level

   Infants with elevation of direct-reacting bilirubin : Urinalysis
    & Urine Culture for sepsis.

   Additional evaluation for Sepsis : CBC, CRP, Blood C/S

   Jaundiced baby at or beyond 3 weeks : measurement of total
    and direct or conjugated bilirubin to identify cholestasis
   Phototharapy => Configurational Isomerization

   Intensive Phototherapy recommended for higher risk

   Bilirubin absorbs light best at 430 - 490 nm, but longer
    wavelength penetrate skin better.

   Skin is exposed as possible & that light is not too far from baby.

   Exchange Transfusion => TSB rises despite of intensive
    phototherapy.

   IVIG => competitive inhibitor of antibodies that cause haemolysis
   American Academy of Pediatrics,

    Sub committee on Hyperbilirubinemia

   Maisels MJ, Watchko JF, Treatment of

    Jaundice in low birth weight infants.

   Ip S , Chung M Kulig J et al. An evidence

    based review of important issues concerning neonatal
    hyperbilirubinemia. Pediatrics 20011,113(6)
Neonatal jaundice cpg

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Neonatal jaundice cpg

  • 2. Neonatal Jaundice : Condition marked by high levels of bilirubin in the blood  Yellowish discoloration of skin & mucous membrane  Bilirubin level >5mg/dl (85 µmol/L)  ‘Cephalo – Caudal distribution’  Normal term neonates : 30% - 50%
  • 3. 1. Physiological Jaundice  Appears within 2 – 3 days (>24hrs of age)  Most common due to immaturity of bilirubin UDGT activity 2. Pathologigal Jaundice  Appears within 24hrs  Common cause : ABO , Rh incompatibility & Sepsis
  • 4. 1. Unconjugated – Lipid Soluble  Hemolytic Disease : ABO, Rh incompatibility  G-6-PD deficiency  Breast Milk Jaundice  High level results in Kernicterus 2. Conjugated – Water Soluble  Conjugated bilirubin >= 20% total bilirubin  DR Alfa ABC GoT Conjugated Hyperbilirubinemia due to sepsis
  • 5. Blood Group O  Rh –ve mother  Previous sibling developed significant hyperbilirubinemia  Infant of diabetic mother (IDM)  Preterm infants
  • 6. For all jaundiced babies : CBC , ABO , RH , TSB , Direct Bilirubin level  Infants with elevation of direct-reacting bilirubin : Urinalysis & Urine Culture for sepsis.  Additional evaluation for Sepsis : CBC, CRP, Blood C/S  Jaundiced baby at or beyond 3 weeks : measurement of total and direct or conjugated bilirubin to identify cholestasis
  • 7. Phototharapy => Configurational Isomerization  Intensive Phototherapy recommended for higher risk  Bilirubin absorbs light best at 430 - 490 nm, but longer wavelength penetrate skin better.  Skin is exposed as possible & that light is not too far from baby.  Exchange Transfusion => TSB rises despite of intensive phototherapy.  IVIG => competitive inhibitor of antibodies that cause haemolysis
  • 8. American Academy of Pediatrics, Sub committee on Hyperbilirubinemia  Maisels MJ, Watchko JF, Treatment of Jaundice in low birth weight infants.  Ip S , Chung M Kulig J et al. An evidence based review of important issues concerning neonatal hyperbilirubinemia. Pediatrics 20011,113(6)