Neonatal jaundice cpg

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Neonatal jaundice cpg

  1. 1. Neonatology Department Hadi Clinic
  2. 2.  Neonatal Jaundice : Condition marked by high levels of bilirubin in the blood Yellowish discoloration of skin & mucous membrane Bilirubin level >5mg/dl (85 µmol/L) ‘Cephalo – Caudal distribution’ Normal term neonates : 30% - 50%
  3. 3. 1. Physiological Jaundice  Appears within 2 – 3 days (>24hrs of age)  Most common due to immaturity of bilirubin UDGT activity2. Pathologigal Jaundice  Appears within 24hrs  Common cause : ABO , Rh incompatibility & Sepsis
  4. 4. 1. Unconjugated – Lipid Soluble  Hemolytic Disease : ABO, Rh incompatibility  G-6-PD deficiency  Breast Milk Jaundice  High level results in Kernicterus2. Conjugated – Water Soluble  Conjugated bilirubin >= 20% total bilirubin  DR Alfa ABC GoT Conjugated Hyperbilirubinemia due to sepsis
  5. 5.  Blood Group O Rh –ve mother Previous sibling developed significant hyperbilirubinemia Infant of diabetic mother (IDM) Preterm infants
  6. 6.  For all jaundiced babies : CBC , ABO , RH , TSB , Direct Bilirubin level Infants with elevation of direct-reacting bilirubin : Urinalysis & Urine Culture for sepsis. Additional evaluation for Sepsis : CBC, CRP, Blood C/S Jaundiced baby at or beyond 3 weeks : measurement of total and direct or conjugated bilirubin to identify cholestasis
  7. 7.  Phototharapy => Configurational Isomerization Intensive Phototherapy recommended for higher risk Bilirubin absorbs light best at 430 - 490 nm, but longer wavelength penetrate skin better. Skin is exposed as possible & that light is not too far from baby. Exchange Transfusion => TSB rises despite of intensive phototherapy. IVIG => competitive inhibitor of antibodies that cause haemolysis
  8. 8.  American Academy of Pediatrics, Sub committee on Hyperbilirubinemia Maisels MJ, Watchko JF, Treatment of Jaundice in low birth weight infants. Ip S , Chung M Kulig J et al. An evidence based review of important issues concerning neonatal hyperbilirubinemia. Pediatrics 20011,113(6)

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