1 / 32

Neonatal Jaundice

Neonatal Jaundice. By Dr Swati Prashant,MD Paediatrics www.paediatrics4all.com drprashantw@gmail.com Index Medical college,Indore,MP,India. JAUNDICE. Jaundice is the commonest abnormal finding during the initial wks .of life .

sonja
Download Presentation

Neonatal Jaundice

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Neonatal Jaundice By Dr Swati Prashant,MD Paediatrics www.paediatrics4all.com drprashantw@gmail.com Index Medical college,Indore,MP,India www.paediatrics4all.com

  2. JAUNDICE • Jaundice is the commonest abnormal finding during the initial wks .of life . • Over 2/3 rd patients develop clinical jaundice . • Typically there is cephalo-pedal progression of yellowish discoloraion of skin . • Normal adult bilirubin is <2 mg /dl. • In newborn it reaches normally upto12-15 mg /dl . www.paediatrics4all.com

  3. Mechanism Of Jaundice • Hb.→ lysis→ Heme +globin • heme → biliverdin by Heme oxygenase. • Biliverdin → Bilirubin by Biliverdin Reductase enzyme. • This Bilirubin (unconjugated) leaves the RE system and enters Plasma . • In blood it is bound to Albumin. www.paediatrics4all.com

  4. Mechanism contd. • IT is carried to the Liver. • Hepatocytes contains a Y Protein (Ligandin ) site on its cell wall membrane . • Bilirubin gets detached from the Albumin and is bound to Y protein . • From here it is taken up inside the cell. • It goes to the Endoplasmic Reticulum of the cell . www.paediatrics4all.com

  5. Mechanism contd. • In ER CONJUGATION takes place with the help of UDPG –T (uridine diphosphate glucoronyl Transferase enzyme. • This conjugated bilirubin is the Direct Bilirubin. • IT is excreted in Bile . • It enters the GIT. • Sterile intestine contains Glucoronidase enzyme . www.paediatrics4all.com

  6. This enzyme degrades conjugated Bilirubin to unconjugated bilirubin . • This is reabsorbed from the gut , enters blood and goes to Liver again for conjugation . • This is called enterohepatic ciculation . www.paediatrics4all.com

  7. Types of Jaundice • 1) Physiological , normal or exaggerated. • 2) Pathological—a) unconjugated (indirect) • b) cojugated (direct ). www.paediatrics4all.com

  8. Physiological jaundice • Criteria • 1)Direct bili. < 2 mg /dl . • 2)Appearance after 36 hrs. Of age. • 3)Rate of rise of Bili. <5 mg /day . • 4)Usually does not exceed > 15 mg /dl . • 5)Peak by 5 th day and disappears by 2 wks . • 6)healhty newborn . www.paediatrics4all.com

  9. Physiological jaundice co. • Why there is a physiological jaundice? • 1)↑ Bilirubin synthesis (↑ RBC load, • enterohepatic circulation • 3)Defective hepatic uptake (↓ Ligandin ,binding Ligandin by others .) • 4)Defective bilirubin conjugation (↓ UDPG activity . • 5)Defective excretion (meconium plug ,delayed feeds . www.paediatrics4all.com

  10. Exaggerated physiological Jaundice • Levels go slightly higher , or may prolong . • Causes---1) Polycythemia, delayed cord clamping, cephalhematoma , IVH . • 2)↓calories , • 3)↓conjugation due to ↓UDPG activity • Hypothyroidism, Breast milk jaundice , drugs . • 4)↓hepatic perfusion—hypoxia CHD www.paediatrics4all.com

  11. jundice • ↑ enterohepatic circulation . www.paediatrics4all.com

  12. Pathological Jaundice • Unconjugated • Conjugated • Unconjugated Hyperbil --- • It is pathological • Occuring mostly within 24 hrs of life . • Total bilirubin >15 mg /dl • Direct bilirubin >2 mg /dl Indirect is more. • Rate of rise is >5 mg/dl . www.paediatrics4all.com

  13. Unconjugated bil . Co . • Indirect bilirubin is ↑. • Causes---- • 1)↑ Bilirubin production • 2 )Rh ,ABO Incompatibility . • 3 ) Hereditary Spherocytosis (shape defects ) • 4 ) Enzyme defects (G6PD deficiency , PYRUVATE Kinase df . αThal. ,large doses of vit K . www.paediatrics4all.com

  14. CAUSES COntd. • 4) SEPSIS • 5)Pyloric stenosis , bowel obstruction • Due to ↓ clearance • Inborn errors of Metabolism • a) Criggler Najjar syndrome type 1 & 2 . • Type 1---AR-- se bil .>30 mg/dl—complete absence of UDPG ACTIVITY . • Type 2---AD --Sr Bil <20 mg ---partial absence- www.paediatrics4all.com

  15. Causes • ↓ clearance may also be due to Hypothyroidism , breast milk jaundice . www.paediatrics4all.com

  16. Rh and ABO Incompatibility. • During labor fetal blood crosses to mother’s side. • Ag. Present in fetal RBC’s cause stimulation of antibody formation in mother . • Ab . Are of IgG TYPE .They cross the placenta in enough amt . In next pregnancy • If the baby is again Rh positive . www.paediatrics4all.com

  17. Isoimmunisation ctd. • In the fetus they produce hemolysis causing anemia and Jaundice . • It may cause Hydrops fetalis . www.paediatrics4all.com

  18. ABO incompatibility • Mothers who are O group + ,carrying A ,B AB Fetus, this fetus can be isoimmunised . • Disease is milder . • Investigations ---Blood group , Indirect Coomb’s test in mother . • Blood group , Direct Coomb’s test ,Sr. Bil. ,CBC , PS , Reti. Count. ,G6PD deficiency . www.paediatrics4all.com

  19. In Criggler Najjar type ---Phenobarbitone is the drug of choice . • In Hypothyroidism , Thyroxine given alleviates jaundice . • Investigations---CBC ,Blood grp. , Sr . Bil . ,Coombs test ,CRP ,Blood C/S ,PS ,G6PD ,TSH , X –ray chest & abd. www.paediatrics4all.com

  20. High Risk group • Prematurity , LBW , Blood group incompatibility , birth asphyxia ,Infants of DM, Oxytocin use , Cephalhematoma , problems in B/F . www.paediatrics4all.com

  21. Complications • Transient encephalopathy • Kernicterus • KERNICTERUS • It is due to bilirubin toxicity of Brain . • It causes staining ,necrosis & gliosis of the neurons . www.paediatrics4all.com

  22. Kernicterus ctd. • Parts affected are • Basal ganglia , Hippocampal cortex ,subthalamic nucleus , cerebellum . • 3 Phases of Kernicterus • 1)Poor sucking , lethargy ,hypotonia • 2)Fever , Hypertonia , Opisthotonus • 3)High pitched cry , convulsions ,coma death. • Choreoathetosis , CP , MR ,Sensorineural deafness . www.paediatrics4all.com

  23. Treatment of Jaundice • Phototherapy • Phenobarbitone • Exchange trnsfusion • T/t of cause—Thyroxine , stop B/F ,sepsis , etc. www.paediatrics4all.com

  24. Phototherapy • Mechanism---1) geometric isomerization—unconjugatd bil . Is converted to more soluble products (Lumirubin ). • 2)stucturalisomerization---bil is excreted in bile without conjugation . • Bilirubin absorbs max . Light in blue range (420—500nm ) www.paediatrics4all.com

  25. Photo . ctd. • Blue and alternate white light used . • Distance of 45 cm is maintained . • Eyes and srotum covered . • Indications ----Sr BIL . >12—15 MG/DL. • Rising titres www.paediatrics4all.com

  26. Complications of Phototherapy • Hyperthermia (20-30 ml/kg of extra fluids given ) • Retinal damage • Bronze baby syndrome(sr . Urine skin becomes brownish . ) • Electric shock. • Loose stools. www.paediatrics4all.com

  27. Exchange Transfusion • It is the most rapid method of lowering sr. Bil. • It removes hemolysed cells and aantibody coated RBC’S. • Amount of blood taken is 180ml/kg • Rh of mother and group of baby is considered in selecting blood. • Umbilical vein is canulised. www.paediatrics4all.com

  28. ET www.paediatrics4all.com

  29. Complications of ET • Sepsis, thrombocytopenia , Portal vein thrombosis , portal or umbilical vein perforation , Arrythmias , cardiac arrest,metabolic disturbances , HIV , HB. • (ET is indicated when • ---cord blood is >5mg • ----cord Hb <10gms. • ---Bil .>10 within 24hrs. www.paediatrics4all.com

  30. Conjugated hyperbil. • Biliary Atresia • Neonatal hepatitis • TORCH infections • Sepsis • Hypothyroidism • Cyst www.paediatrics4all.com

  31. Conjugated Hyperbil. Contd. • It is rare newborn .But is presence always signifies pathology . • Cord blood is>2 mg/dl ,or >15 % of TSB . • In Biliary Atresia , stools are clay coloured , failure to thrive , anemia , vitamin defi.,along with jaundice .T/t is surgery. • Neonatal Hepatitis ---obstutive jaundice is transient.Causes are variable. www.paediatrics4all.com

  32. THANK YOU • Our group websites for students • Pharmacology4students.com • Psm4students.com • Anatomy4students.com • Microbiology4students.com • Biochemistry4students.com • We invite faculties/students to write on topics of undergraduate levels. by dr swati prashant MD. drprashantw@gmail.com

More Related