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Neonatal Jaundice

Neonatal Jaundice. Neonatal Ward Dr. Ziyu Hua. Classification of neonatal jaundice. Physiological jaundice. Pathological jaundice. Etiology of physiological jaundice. In the first few days after birth, haemoglobulin concentration falls rapidly.

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Neonatal Jaundice

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  1. Neonatal Jaundice Neonatal Ward Dr. Ziyu Hua

  2. Classification of neonatal jaundice Physiological jaundice Pathological jaundice

  3. Etiology of physiological jaundice In the first few days after birth, haemoglobulin concentration falls rapidly. Red cell life span of newborn infants is 70 days which is much shorter than that of adults(120 days). Hepatic bilirubin metabolism is less efficiency.

  4. Jaundice is important as A sign of another disorder, e.g. infection, hemolysis Kernicterus: a severe complication of neonatal jaundice, indirect bilirubin (UB) deposited in the brain (basal ganglia).

  5. Warning There are no bilirubin levels which are known to be safe or which will definitely cause kernicterus. Infants who experience severe hypoxia, hypothermia or any serious illness may be susceptible to damage from hyperbilirubinemia.

  6. Severity of jaundice The jaundice starts on the head and face, spreads down the trunk and limbs. How to measure: Observation by eye: blanching the skin Transcutaneous jaundice meter Blood sample: minibilirubin meter

  7. Gestation Preterm infants may be damaged by a lower bilirubin level than term infants. Age from birth is important, higher tolerance with increasing age.

  8. Rate of change Rate of rise tends to be linear until reaching plateau. Rapid rise with increasing harm. Serial measurement of serum bilirubin, suitable intervention when necessary.

  9. Etiology of pathological jaundice Age of onset is a useful guide to likely cause of jaundice. Within 24 hrs During 24 hrs to 2 wks After 2 wks

  10. Jaundice within 24 hrs of age Hemolytic disorders: UB, rise rapidly, high level Rhesus hemolytic disease: jaundice, anemia, hydrops, hepatosplenomegaly; antenatal identify, fetal therapy. ABO incompatibility: less severe, more common, slight or without anemia, peak in the first 12—72hrs. G6PD deficiency: epidemiology; some drugs, infection, hypoxia.

  11. Jaundice within 24 hrs of age Hemolytic disorders Spherocytosis: less common, family history; spherocytes found on the blood film. Congenital infection: conjugated bilirubin, other abnormal clinical signs.

  12. Jaundice at 24 hrs to 2 wks of age Physiological jaundice Infection: unconjugated hyperbilirubinemia; abnormal metabolism of bilirubin; pneumonia, sepsis, hepatitis, urinary tract infection. Other causes: bruising, polycythaemia (venous hematocrit >65%); Crigler-Najjar syndrome (inherited deficiency of enzyme glucuronyl transferase)

  13. Jaundice at 24 hrs to 2 wks of age Breast milk jaundice: prolonged, unconjugated hyperbilirubinemia; unknown cause; declined bilirubin with interruption of breast-feeding; may be harmless. It is unnecessary to stop breast-feeding when breast milk jaundice is diagnosed.

  14. Jaundice at >2 wks of age(persistent) Unconjugated hyperbilirubinemia: Infection, particularly of urinary tract. Congenital hypothyroidism: neonatal biochemical screening; clinical manifestations (constipation, dry skin, coarse facies, hypotonia) Breast milk jaundice: most common, 15% affected; disappears by 3-4 wks of age.

  15. Jaundice at >2 wks of age(persistent) Conjugated hyperbilirubinemia: Neonatal hepatitis syndrome(TORCH), biliary atresia; Dark urine and unpigmented pale stools; Biliary atresia should be diagnosed as soon as possible.

  16. Management No study could prove that supplement with water or dextrose solution would reduce jaundice. Effective treatments: Phototherapy, intense phototherapy Exchange transfusion

  17. Phototherapy Overhead light, blanket, and both of them Blue light: wavelength 450nm, visible Photodegradation: UB is converted into a water-soluble pigment, harmless, excreted in urine Side effects: Uncomfortable eyes, retinal damage in animal, dehydration, rash, diarrhoea, abnormal temperature Phototherapy should not be used indiscriminately.

  18. Exchange transfusion(ET) Indications: Bilirubin rises to the dangerous level; Continues to rise above the recommended level in spite of intensive phototherapy. Transfusion via: cord vessels, peripheral vessels Blood volume: twice infant’s blood volume It should be consider seriously whether to use ET.

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