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Neonatal Jaundice

This document provides an overview of neonatal jaundice. It discusses that jaundice is very common in newborns, affecting 60% of term and 80% of preterm babies. It can be physiological or pathological. Physiological jaundice is usually harmless while pathological jaundice persisting beyond 2 weeks requires investigation. The document outlines the causes, risks, assessment, management including phototherapy and exchange transfusion, and factors that influence jaundice severity. Early prediction and treatment are important to prevent bilirubin encephalopathy or kernicterus, which can cause permanent neurological damage.

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Asad M Amin
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112 views23 pages

Neonatal Jaundice

This document provides an overview of neonatal jaundice. It discusses that jaundice is very common in newborns, affecting 60% of term and 80% of preterm babies. It can be physiological or pathological. Physiological jaundice is usually harmless while pathological jaundice persisting beyond 2 weeks requires investigation. The document outlines the causes, risks, assessment, management including phototherapy and exchange transfusion, and factors that influence jaundice severity. Early prediction and treatment are important to prevent bilirubin encephalopathy or kernicterus, which can cause permanent neurological damage.

Uploaded by

Asad M Amin
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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NEONATAL JAUNDICE

Iqra Idrees
SHO Paediatrics
Introduction

Neonatal jaundice refers to yellow colouration of the skin and sclera of


newborn babies that results from the accumulation of bilirubin in the
skin and mucous membranes.This is also associated with a raised level
of bilirubin in the circulation,a condition known as hyperbilirubinaemia.
 Jaundice is one of the most common conditions requiring medical
attention in newborn babies.
 Approximately 60% of term and 80% of preterm babies develop
jaundice in the first week of life.
 About 10 % of BF babies are still jaundiced at one month of age.
Bilirubin Metabolism

 Red cell breakdown product > Unconjugated bilirubin > mostly


bound to albumin>Metabolised in the liver >Excreted in stools.
 Newborn babies’ RBC have a shorter lifespan, Higher concentration
of RBCs in circulation. The metabolism, circulation and excretion of
bilirubin is also slower than in adults.
Types of Jaundice

 Physiological: Common, harmless, no underlying cause.


More likely to develop in BF babies : Inadequate intake, Sluggish gut
action leading to inc. entro-hepatic circulation of bilirubin , unidentified
factors in breast milk.
Pathological/ Prolonged Jaundice:

 Jaundice persisting beyond the first 14 days in term babies and 21 days in preterm babies.
Causes:
 Blood group incompatibility
 Sepsis
 Metabolic disorders
 Gilbert & Crigler- Najjar syndrome (rare)
 G6PD deficiency
 Biliary Atresia (obstructive jaundice)
Bilirubin encephalopathy & Kernicterus

 Entry of unconjugated bilirubin into the brain can cause both short-
term and long-term neurological dysfunction .
 Acute features: Lethargy, irritability, abnormal muscle tone &
posture ,apnoea & convulsion (Acute bilirubin encephalopathy).
 Chronic features:Athetoid,cerebral palsy, hearing loss, visual & dental
poblems.
RF for Kernicterus

 Serun bilirubin level> 340umol/L in term babies


 Preterm
 sepsis
 Seizures
 Acidosis
 Hypoalbuminaemia
 Rate of rise of bilirubin > 8.5 umol /L per hour (G6PD deficiency, ABO
incompatibility)
Factors that influence hyperbilirubinaemia

 GA <38 weeks
 A previous sibling with NJ requiring phototherapy
 Mother’s intention to breastfeed exclusively
 Visible jaundice in the first 24 hours of life
Early Prediction of Hyperbilirubinaemia

 Measure & record the serum bilirubin level urgently (within 2 hours) in all babies
with suspected or obvious jaundice in first 24 hours of life.
 Continue to measure serum bilirubin level every 6 hours until the level is both
- below the treatment threshold
- stable and/ or falling
 Arrange an urgent referral
 Do not measure bilirubin level routinely in babies who are not visibly jaundiced
 Do not use any of the following to predict significant
hyperbilirubinemia:
umbilical cord blood bilirubin level
umbilical cord blood DAT
Recognition

 In all babies
 Check RF associated for developing significant hyperbilirubinemia
soon after birth
 Examine the baby for jaundice especially in first 72 hours (visual
inspection)
 Babies at high risk should receive an additional visual inspection by a
HCP during the first 48 hours of life
 Do not rely on visual inspection alone in a baby with jaundice
Devices for measuring bilirubin

 Use a transcutaneous bilirubinometer in babies with GA of 35 weeks or more &


postnatal age of > 24 hours
 If transcutaneous biliruinometer is not available , measure the serum bilirubin
 If transcutaneous bilirubinometer indicates bilirubin level > 250umol/L check
serum bilirubin
 Always use serum bilirubin level in babies with jaundice in the first 24 hours of
life & GA less than 35 weeks
 Always use serum bilirubin measurement for babies at or above the relevant
treatment threshold for their postnatal age and subsequent measurements
Formal assessment for the causes

 Full clinical examination


 Serum bilirubin level
 Blood packed cell volume
 Blood group (mother& baby)
 DAT( interpret according to strength of reaction , whether mother received anti D
immunoglobulin)
 Consider if clinically indicated
 FBC& Blood film
 Blood G6PD levels
 C/S of blood , urine and /or CSF (if infection suspected)
Management

 For starting Phototherapy:


 Use bilirubin level ( see threshold table & treatment threshold graphs)
 In babies with GA 38 weeks or more whose bilirubin falls in ‘repeat bilirubin
measurement’ category , repeat levels in 6-12 hours.
 For category ‘consider phototherapy’ repeat levels in 6 hours regardless of
whether or not phototherapy has subsequently been started
 Do not use phototherapy in babies whose bilirubin does not exceed the
phototherapy threshold level
 During Phototherapy
 Repeat serum bilirubin measurements 4-6 hours after initiating phototherapy
 Repeat serum bilirubin measurements every 6-12 hours when the level is stable
or falling
 Stopping Phototherapy
 once level has fallen at least 50 umol/L below the phototherapy threshold &
treatment graphs.
 Check for rebound of significant hyperbilirubinaemia with a repeat serum
bilirubin 12-18 hours after stopping phototherapy. Babies do not necessarily have
to remain in hospital for this.
 Exchange Transfusion
 IVIG

 Provide information and support to parents/carers of babies with


neonatal jaundice.
Thank You

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