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Yellow Baby

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Yellow Baby

  1. 1. ellow aby Maryam AL-Qahtani
  2. 2. • Draw up a diagnostic and treatment plan on the basis of the probability diagnosis? • Would it make any difference to your differential diagnosis if the child was 1 day old rather than 3 day old ? OR 10 day old? Give reasons for your answer. Learning Objectives
  3. 3. n ro uction Jaundice occurs in approximately 60% of newborns but only a few will require investigation and treatment.
  4. 4. Draw up a diagnostic on the basis of the probability diagnosis?
  5. 5. A transcutaneous bilirubinometer:
  6. 6. Serum bilirubin:
  7. 7. LFTs: Aspartate aminotransferase (ASAT ) and alanine aminotransferase (ALAT ) levels are elevated in: Hepatocellular disease. Alkaline phosphatase and γ- glutamyltransferase(GGT) levels are often elevated in: cholestatic disease.
  8. 8. Toxoplasmosis, rubella, herpes simplex Surface swabs including umbilicus, throat swabs, urine culture, blood culture, lumbar puncture, CXR. Infection screen:
  9. 9. Reducing substance in urine: Screening test for galactosaemia
  10. 10. Thyroid function tests:
  11. 11. Blood type and Rh determination in mother and infant. Reticulocyte count. Haemoglobin and haematocrit values. Direct coombs test Peripheral blood film for erythrocyte morphology. Red cell enzyme assays: glucose-6-phosphate dehydrogenase activity (G6PD deficiency), pyruvate kinase deficiency. Hemolytic work-up :
  12. 12. Ultrasound, radionuclide scan, liver biopsy may be required for cholestatic jaundice in the differentiation between hepatitis and biliary atresia.
  13. 13. Draw up a treatment plan on the basis of the probability diagnosis?
  14. 14. Doctors, nurses, and family members will watch for signs of jaundice at the hospital and after the newborn goes home.
  15. 15. When treatment is needed, the type will depend on: •The baby's bilirubin level. •How fast the level has been rising. •Whether the baby was born early .
  16. 16. IF Physiological jaundice : The type seen in most newborns -- does not require aggressive treatment. with frequent feedings the baby often (up to 12 times a day) to encourage frequent bowel movements. These help remove bilirubin through the stools. And exposure to indirect sunlight at home. It will typically disappear in a few days (within 1 -2wk.) Doctors may test the baby's bilirubin levels during that time to make sure it has not gotten worse.
  17. 17. Phototherapy treatment Exchange transfusion Intravenous immunoglobulin IF baby has more severe jaundice, she/he may need treatment including:
  18. 18. When unconjugated bilirubin is > 12 mg/dl (> 205.2 μmol/L) And when unconjugated bilirubin is > 15 mg/dl at 25 to 48 h, 18 mg/dl at 49 to 72 h, and 20 mg/dl at > 72 h Phototherapy is not indicated for conjugated hyperbilirubinemia. Indication: Phototherapy treatment
  19. 19. Phototherapy is the use of light to photoisomerize unconjugated bilirubin into forms that are more water- soluble and can be excreted rapidly by the liver and kidney.  It provides definitive treatment of neonatal hyperbilirubinemia and prevention of kernicterus. Phototherapy treatment Treatment with phototherapy is successful for almost all infants.
  20. 20. Side effects: • Phototherapy is very safe, but it can have temporary side effects, including a skin rash and loose bowel movements. • Overheating and dehydration can occur if the infant does not get enough breast milk or formula. Phototherapy is stopped when bilirubin levels decline to a safe level.
  21. 21. is done to prevent or minimize bilirubin-related brain damage. The transfusion replaces an infant's blood with donated blood in an attempt to quickly lower bilirubin levels. performed in infants who have not responded to other treatments Exchange transfusion :
  22. 22. oBilirubin >340 micromol/L oWho have signs of or are at significant neurologic risk of bilirubin toxicity Indications: Risks of exchange transfusions: (uncommon) include: bradycardia vasospasm air embolism infection thrombosis
  23. 23. If a baby have different blood types, may get immunoglobulin (a blood protein) through a needle into a vein. This can help her treat her jaundice so that she’s less likely to need an exchange transfusion. Intravenous immunoglobulin (also called IVIg):
  24. 24. Would it make any difference to your differential diagnosis if the child was 1 day old rather than 3 day old ? OR 10 day old? Give reasons for your answer.
  25. 25. Best classified by age of onset and duration: 1.Early: within 24 hrs of life. 2.Intermediate: 2 days to 2 weeks. 3.Late: persists for >2 weeks.
  26. 26. Early: Haemolytic causes: Rh incompatibility- ABO incompatibility- G6PD deficiency Congenital infection .  Increased haemolysis due to haematoma.  Maternal autoimmune haemolytic anaemia: eg, systemic lupus erythematosus. Crigler-Najjar syndrome.  Gilbert's syndrome.
  27. 27. • Physiological jaundice • Breast milk jaundice (inadequate intake) • Sepsis • Haemolysis • Crigler-Najjar syndrome (glucuronyl transferase absent/reduced) • Polycythaemia • Hypothyroidism, hypopituitarism. • Galactosaemia. Intermediate:
  28. 28. • Conjugated (dark urine, pale stools): – Bile duct obstruction – Biliary atresia – Neonatal hepatitis • Unconjugated: – Physiological (rare). – Breast milk jaundice – Infection – Hypothyroidism
  29. 29. References • Kliegman Book. • Merck Manual • http://www.health.vic.gov.au/neonatalhandbook/conditions/jaundice-in- neonates.htm • http://www.nlm.nih.gov/medlineplus/ency/article/001559.htm • http://www.emedicinehealth.com • http://www.healthline.com • http://www.patient.co.uk/doctor/neonatal-jaundice-pro • http://www.nhs.uk/conditions/jaundice-newborn/pages/treatment.aspx
  30. 30. Than k you