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Audit of babies Admitted in SCBU with Neonatal Jaundice
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19th May 2006. James Paget Hospital. . Introduction . Jaundice is the most common condition requiring medical attention in neonatesYellow discolouration of skin and mucous membrane in neonates is due to unconjugated bilirubinUnconjugated bilirubin can pass BBB and is neurotoxic. 19th May 2006. 
Audit of babies Admitted in SCBU with Neonatal Jaundice
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19th May 2006
James Paget Hospital Introduction Jaundice is the most common condition requiring medical attention in neonates
Yellow discolouration of skin and mucous membrane in neonates is due to unconjugated bilirubin
Unconjugated bilirubin can pass BBB and is neurotoxic
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19th May 2006
James Paget Hospital Introduction Jaundice might be the first presentation of numerous diseases
Investigations are needed to find underlying causes
Treatment should be instituted early to prevent permanent damages
Neonates are at high risk of getting jaundiced as they have high erythrocytic mass and turnover & immature liver
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19th May 2006
James Paget Hospital Introduction Physiological Jaundice
Usually harmless in healthy term neonate
Never appears on first day
Peaks on 3rd & 4th day ,resolves by 2nd – 4th week.
Breast milk jaundice
peaks at 4th – 6th day
May persist up to 2 – 3 months
Not an indication to stop breast feeding
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19th May 2006
James Paget Hospital Introduction Premature, LBW & unwell babies need treatment at lower levels
Conjugated hyperbilirubinaemia needs investigations
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19th May 2006
James Paget Hospital Causes < 24 hours
Rh haemolytic disease
ABO incompatibilities
G6PD & other enzyme deficiencies
Congenital Spherocytosis
Congenital infections (eg. TORCH)
Galactosaemia
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19th May 2006
James Paget Hospital Causes 2nd – 5th day
Physiological ( Commonest)
Bruising/Cephahaematoma
Polycythaemia
Infections
Haemolysis
Galactosaemia
Familial Non-haemolytic jaundice
Metabolic (Amino acidopathies, organic acidaemias)
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19th May 2006
James Paget Hospital Causes Prolonged
Same as above
Breast milk jaundice( commonest)
Hypothyroidism
Neonatal hepatitis
Biliary tract problems
CF
?lpha 1 AT deficiency
TPN hepatitis
Dubin Johnson/Rotor Syndrome
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19th May 2006
James Paget Hospital The Audit: Aim Are we following trust guidelines for investigation Neonatal jaundice ?
Does the guideline need any revision ?
How can we improve our practice ?
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James Paget Hospital Methodolgy Retrospective descriptive study
Period of study : 1st Jan to 30th June 2005
All admissions to SCBU scanned for jaundice
Doctor’s & nursing notes taken into account
Total number of notes scanned :85
Total no. of neonates with jaundice : 46
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19th May 2006
James Paget Hospital Indications for investigating Neonatal Jaundice Onset < 24 hrs
Premature
SBR>310 at 48hrs
SBR>360 thereafter
Prolonged >14 days –term
>21 days-preterm
Pale stools & dark urine
Unwell/Septic
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James Paget Hospital Unwell ( n=20)
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James Paget Hospital Premature Neonates ( n=22)
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19th May 2006
James Paget Hospital How Was The Neonate Managed?
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19th May 2006
James Paget Hospital Some misses !! One unwell,prem had jaundice <24 hrs, 1st SBR was above treatment line, not acted upon.
One had SBR in Exchange Transfusion Range , phototherapy was continued.
4 neonates,all prems had SBR above treatment line but no documentation & not acted upon
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James Paget Hospital Summary SBRs done in all jaundiced babies
85% of all babies with neonatal jaundice had FBC with differentials
100% of all unwell babies with jaundice had FBC with differentials
100% of all babies with jaundice <24 hrs had FBC with Retics and BMs
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19th May 2006
James Paget Hospital Summary Only 4/46 (30%) of all neonates with jaundice had DCT and blood group
1/3 (33%) of neonatal jaundice <24 hrs didn’t have DAT& grouping.
Only 1/3 (33%) of neonatal jaundice <24 hrs had rate of rise monitored
None of the neonates with jaundice <24 hrs had TORCH screen
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19th May 2006
James Paget Hospital 2/20 (10%) Unwell/Septic neonate had no Septic Screen
None of 42 (100%) unwell+/- premature babies had MSU
Only 2/20(10%) of unwell neonates had LP
5/46 (11%) of jaundiced neonates not picked up, all were premature (32 to 34 weeks), one of them, unwell prem.
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19th May 2006
James Paget Hospital Special notes Nursing notes were more explanatory than doctor’s notes….. as usual !!
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19th May 2006
James Paget Hospital Recommendations Better documentation
Chasing SBR results
Revision of guideline to make it clearer
Re-audit in a year
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19th May 2006
James Paget Hospital
30. Thank You !
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Audit of babies Admitted in SCBU with Neonatal Jaundice - 19th May 2006. James Paget Hospital. . Introduction . Jaundice is the most common condition requiring medical attention in neonatesYellow discolouration of skin and mucous membrane in neonates is due to unconjugated bilirubinUnconjugated bilirubin can pass BBB and is neurotoxic. 19th May 2006.
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Audit of babies Admitted in SCBU with Neonatal Jaundice - 19th May 2006. James Paget Hospital. . Introduction . Jaundice is the most common condition requiring medical attention in neonatesYellow discolouration of skin and mucous membrane in neonates is due to unconjugated bilirubinUnconjugated bilirubin can pass BBB and is neurotoxic. 19th May 2006.
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Fototerapia para a icter cia neonatal Phototherapy for neonatal jaundice - Caso Cl
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Neonatal Jaundice - NJ - 2. Teaching Aids: NNF. Bilirubin metabolism. . . . . Hb ? globin haem1g Hb = 34mg bilirubin. Non
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Neonatal jaundice -
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Neonatal Jaundice -
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Neonatal Jaundice - Introduction . Neonatal Jaundice is known as the visible clinical manifestation of dying skin and sclera yellow during the neonatal period, resulting from deposition of bilirubin in the neonatal bodies.. Introduction . Jaundice is observed during the 1st wk in approximately 60% of term infant and 80% of preterm infant.Hyperbilirubinemia can be toxic, with high levels resulting in an encephalopathy known as kerni-cterus..
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NEONATAL JAUNDICE - TRANSPORT OF BILIRUBIN IN PLASMA. Unconjugated bilirubin binds to albumin in a 2:1 molar ratio. Organic anions take % of binding sites. 25 mg/100 m1 UCB saturates all sites of 3 gm/10q m1. albumin. Albumin binding is affected by: hypoxia, ph, hypoglycemia, orga
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neonatal jaundice - CAUSES OF PHYSIOLOGIC HYPERBILIRUBINEMIA - 1. Definition: Full term infant 6-8 mg/l00 ml by 3 daysPremature infant 10-15 fig/100 ml by 5 daysAn increased bilirubin load : more than 8.5 mg/kg/day Increased RBCs volume/kgDecreased fetal RBCs survival - 90 daysIncreased early-labeled bilirubinIncreased resorption of bilirubin from intestines.
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NEONATAL JAUNDICE - Definition . JAUNDICE: yellowish discoloration of skin, sclera and mucus membraneResults from accumulation of un conjugated bilirubin pigment in the skin occur in 60% of term infant and 80% of preterm infant.. Bilirubin production . Bilirubin is a product of heme catabolism. Approximately 80 to 90%
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