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Neonatal Jaundice

Causes and Management of Jaundice in the Newborn babies.
by

Krishnan Balasubramanian

on 28 June 2013

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Transcript of Neonatal Jaundice

Neonatal
Jaundice
Why?
Source of Bilirubin
Bilirubin Metabolism
Physiologic
Hyperbilirubinemia
Non physiologic Hyperbilirubinemia
Breast Feeding
What
to
do?

Family H/o Haemolysis
Family H/o Liver disease
Ethnic origin
Sibling with jaundice
Maternal illness
Labour and delivery
Feeding history
Vomiting / BO
Prematurity / SGA
Microcephaly
Extravascular blood
Pallor
Petechiae
Organomegaly
Infection
Approach
Treatment
Exchange
Transfusion in HDN
Other interventions
Dr K Balasubramanian
1. RBC - Haemoglobin
75% of Bilirubin
1gm of Hb = 34mg of bilirubin

2. Early Labelled Bilirubin
25% Bilirubin
From Hb released by ineffective eryhropoiesis in the marrow
From other heme containing proteins


Increased Bilirubin production
Defective uptake
Defective conjucation
Decreased hepatic excretion
Onset < 24 hrs
Increase of bili > 8 mmol/hr
Sick infant
Jaundice > 14 days
Breast-milk Jaundice
Onset by D 4
Unknown mechanism
Increased enterohepatic circulation
Slower to colonise with bacteria
Well babies
Breast - feeding Jaundice
First 3-4 days
Decreased intake of milk
Complications
Free Bilirubin or bound bilirubin (disrupted BBB)
Toxicity levels vary
Kernicterus - chronic and permanent sequele
Acute & Chronic encephalopathy
History
Examination
General measures
Correct acidosis, hypoxia, sepsis, hypoalbuminemia
Phototherapy
Phenobarbitol
Mechanism:
Photoisomerisation
Structural isomerisation
(most important as irreversible)
Photoxidation

Side effects:
Insensible water loss
Diarrohea
Retinal damage
'Bronze baby'
Mutations / DNA breaks
Replaces antibody coated RBC
Bilirubin binds with albumin
Bilrubin - 60% of pre-exchage level

Double volume exchange
O neg, crossmatched agains mother & infant

Hypocalcemia/ hypomagnesimia
Hypoglycemia
Acid base disturbance
Hyperkalemia
Bleeding / GVHD
0.5 -1 gm/kg
Systemic Review by Gottstein found it reduces the need for Ex Tx ( ADC Neonatal Ed 2003;88:F6-F10 doi:10.1136/fn.88.1.F6 )
Cochrane found similar results but the results not applicable.Cochrane Database Syst Rev. 2002;(3):CD003313.
An observational, retrospective study that encompassed 16 years was conducted. A total of 492 liveborn infants who were of 34 weeks' gestation. A total of 167 (34%) infants received IVIG. was diagnosed in 11 (2.2%) patients: 10 (6%) in the IVIG-treated group and 1 (0.3%) in the non–IVIG-treated group. ( PEDIATRICS Vol. 125 No. 1 January 2010, pp. 139-144 )
IV Ig
Phototherapy
NEC
?
?
Full transcript