Your SlideShare is downloading. ×
0
Neonatal Jaundice
Dr. Abhijeet Deshmukh
DNB Pediatrics
PIMS & RC, Tiruvalla
Neonatal Jaundice
• Learning Objectives:
• Define hyperbilirubinemia.
• Differentiate between physiological and
pathologic...
Neonatal Jaundice
(Hyperbilirubinemia)
• Definition: Hyperbilirubinemia refers to an
excessive level of accumulated biliru...
NJ - 4
Neonatal Jaundice
• Visible form of bilirubinemia
–Newborn skin >5 mg / dl
• Occurs in 60% of term and 80% of preterm
neon...
Bilirubin metabolism
Hb → globin + haem
1g Hb = 34mg bilirubin
Non – heme source
1 mg / kg
Bilirubin
glucuronidase
Bilirub...
NJ - 7
Bilirubin Production & Metabolism
Clinical assessment of jaundice
(Kramer’s staging)
Area of body Bilirubin levels
mg/dl (*17=umol)
Face Zone-1: 4-6
Upper t...
Physiological jaundice
Characteristics
• Appears after 24-72 hours
• Maximum intensity by 3th-5th day in term &
7th day in...
Why does physiological jaundice
develop?
• Increased bilirubin load.
• Defective uptake from plasma.
• Defective conjugati...
Pathological jaundice
• Appears within 24 hours of age
• Increase of bilirubin > 5 mg / dl / day
• Serum bilirubin > 15 mg...
Causes of jaundice
Appearing within 24 hours of age
• Hemolytic disease of NB : Rh, ABO
• Infections: TORCH, malaria, bact...
Causes of jaundice
Appearing between 24-72 hours of life
• Physiological
• Sepsis
• Polycythemia
• Intraventricular hemorr...
Causes of jaundice
After 72 hours of age
• Sepsis
• Cephalhaematoma
• Neonatal hepatitis
• Extra-hepatic biliary atresia
•...
Breast feeding jaundice
• In exclusively breast feed infants
• Appears at 24-48 hrs of age
• Peaks by 5-15 days
• Disappea...
Breast milk jaundice
• In 2-4 % EBF babies
• SBr>10mg/dl beyond 3rd-4th week
• Should be differentiated from Hemolytic
jau...
Risk factors for jaundice
JAUNDICE
• J - jaundice within first 24 hrs of life
• A - a sibling who was jaundiced as neonate...
Diagnostic evaluation:
• Normal values of unconjugated B. are 0.2 to
1.4 mg/dL.
• Investigate the cause of jaundice.
Therapeutic Management
• Purposes: reduce level of serum bilirubin and
prevent bilirubin toxicity
• Prevention of hyperbil...
Babies under phototherapy
Baby under conventional
phototherapy
Baby under triple unit intense
phototherapy
Prognosis
• Early recognition and treatment of
hyperbilirubinemia prevents severe brain
damage.
Nursing considerations of Hyperbilirubinemia
• Assessment:
 observing for evidence of
jaundice at regular intervals.
 Ja...
Approach to jaundiced baby
• Ascertain birth weight, gestation and postnatal age
• Ask when jaundice was first noticed
• A...
The goals of planning
• Infant will receive appropriate therapy if
needed to reduce serum bilirubin levels.
o Infant will ...
Thank You!
Upcoming SlideShare
Loading in...5
×

Neonatal jaundice

6,472

Published on

Published in: Health & Medicine
1 Comment
12 Likes
Statistics
Notes
No Downloads
Views
Total Views
6,472
On Slideshare
0
From Embeds
0
Number of Embeds
1
Actions
Shares
0
Downloads
659
Comments
1
Likes
12
Embeds 0
No embeds

No notes for slide

Transcript of "Neonatal jaundice"

  1. 1. Neonatal Jaundice Dr. Abhijeet Deshmukh DNB Pediatrics PIMS & RC, Tiruvalla
  2. 2. Neonatal Jaundice • Learning Objectives: • Define hyperbilirubinemia. • Differentiate between physiological and pathological jaundice. • Causes of hyperbilirubinemia. • Discuss the pathophysiology of hyperbilirubinemia. • Describe the most dangerous complication of hyperbilirubinemia. • therapeutic management. • Design plan of care for baby has hyperbilirubinemia.
  3. 3. Neonatal Jaundice (Hyperbilirubinemia) • Definition: Hyperbilirubinemia refers to an excessive level of accumulated bilirubin in the blood and is characterized by jaundice, a yellowish discoloration of the skin, sclerae, mucous membranes and nails. • Unconjugated bilirubin = Indirect bilirubin. • Conjugated bilirubin = Direct bilirubin.
  4. 4. NJ - 4
  5. 5. Neonatal Jaundice • Visible form of bilirubinemia –Newborn skin >5 mg / dl • Occurs in 60% of term and 80% of preterm neonates • However, significant jaundice occurs in 6 % of term babies • 6-10% require phototherapy/ other therapeutic options.
  6. 6. Bilirubin metabolism Hb → globin + haem 1g Hb = 34mg bilirubin Non – heme source 1 mg / kg Bilirubin glucuronidase Bilirubin Bilirubin Ligandin (Y - acceptor) Bil glucuronide Intestine Bil glucuronide Stercobilin bacteria β glucuronidase
  7. 7. NJ - 7 Bilirubin Production & Metabolism
  8. 8. Clinical assessment of jaundice (Kramer’s staging) Area of body Bilirubin levels mg/dl (*17=umol) Face Zone-1: 4-6 Upper trunk Zone-2: 6-8 Lower trunk & thighs 8-16 Arms and lower legs Zone-3: 8-12 Palms & soles Zone-4 :12-14 Zone-5 :>15
  9. 9. Physiological jaundice Characteristics • Appears after 24-72 hours • Maximum intensity by 3th-5th day in term & 7th day in preterm • Serum level less than 15 mg / dl • Clinically not detectable after 14 days • Disappears without any treatment Note: Baby should, however, be watched for worsening jaundice.
  10. 10. Why does physiological jaundice develop? • Increased bilirubin load. • Defective uptake from plasma. • Defective conjugation. • Decreased excretion. • Increased entero-hepatic circulation.
  11. 11. Pathological jaundice • Appears within 24 hours of age • Increase of bilirubin > 5 mg / dl / day • Serum bilirubin > 15 mg / dl • Jaundice persisting after 14 days • Stool clay / white colored and urine staining clothes yellow • Direct bilirubin> 2 mg / dl
  12. 12. Causes of jaundice Appearing within 24 hours of age • Hemolytic disease of NB : Rh, ABO • Infections: TORCH, malaria, bacterial • G6PD deficiency
  13. 13. Causes of jaundice Appearing between 24-72 hours of life • Physiological • Sepsis • Polycythemia • Intraventricular hemorrhage • Increased entero-hepatic circulation
  14. 14. Causes of jaundice After 72 hours of age • Sepsis • Cephalhaematoma • Neonatal hepatitis • Extra-hepatic biliary atresia • Breast milk jaundice • Metabolic disorders (G6PD).
  15. 15. Breast feeding jaundice • In exclusively breast feed infants • Appears at 24-48 hrs of age • Peaks by 5-15 days • Disappears by 3rd week • Its related to inadequate B.F • T/t:Proper & adequate B.F
  16. 16. Breast milk jaundice • In 2-4 % EBF babies • SBr>10mg/dl beyond 3rd-4th week • Should be differentiated from Hemolytic jaundice, hypothyroidism, G6PD def • T/t: Some babies may require PT Continue breast feeding Usually declines over a period of time
  17. 17. Risk factors for jaundice JAUNDICE • J - jaundice within first 24 hrs of life • A - a sibling who was jaundiced as neonate • U - unrecognized hemolysis • N – non-optimal sucking/nursing • D - deficiency of G6PD • I - infection • C – cephalhematoma /bruising • E - East Asian/North Indian
  18. 18. Diagnostic evaluation: • Normal values of unconjugated B. are 0.2 to 1.4 mg/dL. • Investigate the cause of jaundice.
  19. 19. Therapeutic Management • Purposes: reduce level of serum bilirubin and prevent bilirubin toxicity • Prevention of hyperbilirubinemia: early feeds, adequate hydration • Reduction of bilirubin levels: phototherapy, exchange transfusion, • Drugs Use of Phenobarbital promote liver enzymes and protein synthesis.
  20. 20. Babies under phototherapy Baby under conventional phototherapy Baby under triple unit intense phototherapy
  21. 21. Prognosis • Early recognition and treatment of hyperbilirubinemia prevents severe brain damage.
  22. 22. Nursing considerations of Hyperbilirubinemia • Assessment:  observing for evidence of jaundice at regular intervals.  Jaundice is common in the first week of life and may be missed in dark skinned babies Blanching the tip of the nose
  23. 23. Approach to jaundiced baby • Ascertain birth weight, gestation and postnatal age • Ask when jaundice was first noticed • Assess clinical condition (well or ill) • Decide whether jaundice is physiological or pathological • Look for evidence of kernicterus* in deeply jaundiced NB *Lethargy and poor feeding, poor or absent Moro's, or convulsions
  24. 24. The goals of planning • Infant will receive appropriate therapy if needed to reduce serum bilirubin levels. o Infant will experience no complications from therapy. o Family will receive emotional support.
  25. 25. Thank You!
  1. A particular slide catching your eye?

    Clipping is a handy way to collect important slides you want to go back to later.

×