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بسم الله الرحمن الرحيم

بسم الله الرحمن الرحيم. Jaundice in the newborn DR Husain Alsaggaf. Jaundice in the newborn. Clinical jaundice appear at SB 5 mg/dl 25% to 50% of term newborns have clinical jaundice. Jaundice may caused by serious illness or lead to keriniectrus.

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بسم الله الرحمن الرحيم

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  1. بسم الله الرحمن الرحيم Jaundice in the newborn DR Husain Alsaggaf

  2. Jaundice in the newborn • Clinical jaundice appear at SB 5 mg/dl • 25% to 50% of term newborns have clinical jaundice. • Jaundice may caused by serious illness or lead to keriniectrus. • 75% of bilirubin comes from haemoglobin and 25% from other sources

  3. Neonatal jaundice

  4. Physiological jaundice • Start after the first 24hours. • Peak in the fourth or fifth day {not >12 mg/dl} in term babies and not more than 15 mg/dl in premature • The baby is well. • Clear in week in term and two weeks in premature. • Bilirubin is unconjucated. • The rise is not more than 0.5 mg /h

  5. Causes of physiological jaundice • High haemoglobin • Decrease RBC life span. • Increase enterohepatic circulation. • Defective conjugation. • Decrease hepatic excretion

  6. Pathological jaundice Unconjucated • High Hg mass • Haemolysis. • Blood group incompqatability.(RH.ABO.) • Red cell membrane defect (spherocytosis) • Heamoglobinopathy. • Haemolytic agents (vit k3.oxytocin) • Infection E.coli septicaemia

  7. Causes of unconjucated hyperbiliruniemia • Liver cell membrane defect (GILBRET). • Defective conjugation. • Jaundice of prematurity. • Breast milk jaundice. • Hypothyroidism. • Hereditary(crigler-najjar). • Other conditions Pyloric stenosis,infant of diabetic mother, down's syndrome

  8. Investigation of unconj-hyberbilirubinneamia • Split biliurubin. • Blood groups and Rh. • coomb’s test. • CBC and reticulocyte. • G-6-P-D estimation Blood film and osmotic fragility test. TFT and urine for reducing substance.

  9. Causes of conjugated hyberbilirubineamia • Hepatitis: CMV.toxoplasmosis.rubella.herpes.giant cell,Hep A and b,syphilis,E coli. • Metabolic: Galctosemia,Tyroseanemia,Fructoseamia. • Cystic fibrosis. • Alpha one anti trypsin deficiency. • Gauchers and neimman pick • Biliary Artesia (intrahepatic and extrahepatic) • Choldoccal cyst. • T.P.N

  10. Investigation of conjugated hyperbiliruniemia • L.F.T • PT.PTT. • Urine for glucose and reducing substance. • Serum and urine amino acid determinations. • TORCH serology. • Ultrasound. • Liver scan • Duodenal aspiration. • Liver biopsy.

  11. History. FH of aneamia,spleenomegaly. Jaundice in other sibling (breast milk jaundice.Rh disease) FH of liver disease (galactoseamia,alpha-one- antitrypsin difficiency,cystic fibrosis, Gilbert and crigler-najjar) Maternal illness during pregnancy (TORCH and diabetes). Maternal drugs.(sulfanomide Labour and delivery(Truma,oxytocin,delayed clamping of the cord,prematurity. Infant history. Feeding (breast milk jaundice). Poor feeding. Vomting(sepsis pyloric stenosis,galactosemia Approach To neonatal jaundice

  12. Examination • Small for date(polycythemia, in-utroinfection. • Premature • Extravagated blood(briuses ,cephaloheamatoma). • Pallor(heamolytic anaemia and extravagated blood) • Cherioretinitis,cataract,(congenital infection,galactoseamia) • Petechia rash (congenital infection,galactoseamia) • Hepatospleenomegaly(heamolytic anaemia ,congenital infection, liver diseases)

  13. Management • Prevention: • Rh incompatibility----- Anti D • Syphlis---Pencilline • Specific therapy: • Septicaemia---- Antibiotic. • Surgery------------ Ex hepatic biliary Artesia. • Galctose withdrawal for galactoseamia.

  14. Management of unconjucated hyberbilirubineamia

  15. Phototherapy • Wave length 450-460 -- Reduce bilirubin To harmless compound excreted in the urine. • Complication: • Retinal damage, nasal obstruction, mild diarrhea,dehydration,bronzed baby syndrome

  16. Exchange Transfusion • Indicated when bilirubin reach toxic level. • Mortality1% • Remove bilirubin ,antibodies ,correct anaemia. • Double blood volume is used 85 ml /kg • COMPLICATION. • Infection,acidosis,Cadiac failure, Electrolytes imbalance.

  17. Phenobarbitone • This act as enzyme inducer which increase amount of glucoreny transferase and protein z. • Used in crigler najjar

  18. Kernicterus • Yellow staining of nuclear centres of the brain • Due to high level of indirect bilirubin. • Bilirubin cause neural loss. • Bilrubin inhibit cell respiration, protein synthesis,glucouse metabolism. • Poor feeding and lethargy- fits,rigidityspacsticty deafnes,athetosis

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