**Neonatal Jaundice Flashcards
Physiological vs pathological jaundice
Physiological:
1. 2nd to 3rd day of life (term)
2. Disappears by 5th day of life (term)-7th
3. Peaks at second to third day of life
4. Peak bilirubin <13 mg/dL (term)
5. Rate of bilirubin rise <5 mg/dL/d
Pathological:
1. May appear in first 24 hours of life
2. Variable
3. Variable
4. Unlimited
5. Usually >5 mg/dL/d
Bilirubin pathway
Hemoglobin …
Heme + globulin …
Heme to bilviridin …
Bilirubin (unconjugated/indirect) …
LIVER
*GLUCURONYL TRANSFERASE
Conjugated bilirubin …
Common bile duct …
GIT …
Urobilinogen
Stercobilinogen
List causes of Unconjugated hyperbilirubinemia
- Physiological
- Breast milk jaundice
- Hemolysis - ABO/Rh incompatibility
- Non-hemolytic RBC destruction - cephelhaematoma, polycythemia
- Sepsis
- Hypothyroidism
- Git obst - pyloric stenosis
- Prematurity
- G-6 PD
Erythroblastosis fetalis
Rh -ve mum
1st baby Rh + … mixed with mums blood …
Antibodies for Rh+
2nd baby Rh + … blast
Blood transfusion for mum @34wks and at birth
Jaundice in first 24hrs
Immediate phototherapy
*AUDIOMETRY and development assessing req
Physiological unconjugated hyperbilirubinemia
Liver too weak to manage haemolysis
Resolve with in
● 1-2 wks in term
● 3wks in pre-term
Mx of physiological unconjugated hyperbilirubinemia
- Sunlight exposure NOT RECOMMENDED
- Phototherapy - nomogram
- Exchange transfusion
{First 24-36 hrs
>170 micromol/l - Phototherapy
»250micro mol/l (15mg/dl)- exchange transfusion}
Phototherapy
1st day - >150mcmol/L or >10mg/dl
2nd day - >200mcmol/l or >14mg/dl
3rd day - >250mcmol/l or >18mg/dl
exchange transfusion
1st day - >250mcmol/L or >15mg/dl
2nd day - >300mcmol/l or >18mg/dl
3rd day - >350mcmol/l or >20mg/dl
Immune mediated hemolysis examples, coombs +/- ?
- Erythroblastosis fetalis
- ABO incompatibility (O+ mum, A/B baby)
- Kell (blood group) negative mum
*DIRECT COOMBS TEST +
Non immune mediated hemolysis examples, coombs?
- Hereditary spherocytosis
- Enzyme deficiency
● G-6 PD
● Pyruvate kinase deficiency
Coombs -ve
Conjugated hyperbilirubinemia etiology
●↓Glucuronyl transferase (GT) activity
1. Physiological 1st week
2. Systemic d/o affecting liver first - sepsis, TORCH, metabolic
●GT activity absent
1. Crigler-najjar syndrome (type 1)
●Biliary atresia
●↑Entero-hepatic circulation - intestinal obstruction
Biliary atresia c/f
Jaundice in first 2 wks of life
Symptoms:
1. Lethargic
2. Vomiting
Signs:
1. Conjugated hyperbilirubinemia
2. Dark urine, pale stools
3. Hepatospleenomegaly
Biliary atresia dignosis
●Initial -
USG: triangular fibrotic cord at porta hepatis
no Gb, no ducts
●Best -
Percutaneous Liver biopsy (not req in most cases)
Biliary atresia Rx
●Initial- KASAI PROCEDURE
Hepato portojejunostomy
●Best - long term
Liver transplant
Breast feeding jaundice
D/t lack of proper feeding
Lack of calories - Jaundice
Mx:
Rehydrate baby
Lactation consult for mum
*Breast milk jaundice
- D/t enzyme glucuronidase in breast milk
- Diagnosis of exclusion,
not necessary - suspending (not stopping feed) for 1-2 days - Starts 1st week
peaks 2-3wks
can last for months - No rx req, continue feed
Mx of hyperbilirubinemia
Phototherapy
-BRONZE BABY SYN in DIRECT/CONJU
Exchange transfusion
