2. INTRODUCTION
Neonatal jaundice is the common clinical sign that has been
encountered among newborn babies
60% of term and 80% of preterm neonates develop jaundice
during first week of life
Around 10% needs treatment
High Bilirubin level toxic to brain- Acute Bilirubin Encephalopathy/
Kernicterus
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5. PHYSIOLOGICAL JAUNDICE
Breast feeding Jaundice
Usually appears between 24-72 hrs
Peak by 5-15 days- resolve by 3 weeks
1/3 persist beyond 3 week -3 months
Inadequate feeding
Ensuring optimum feeding
Breast milk Jaundice
2-4 %- 3-4 week of life(> 10mg%)
Diagnosis of exclusion
Some baby needs treatment
No need to stop breast feeding
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6. CLINICAL QUANTIFICATION- KRAMER INDEX
High bilirubin
After phototherapy
Inexperienced observer
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4-6 mg
6-8 mg
8-12 mg
12-15
mg
>15 mg
TcB –Transcutaneous Bilirubinometer
7. TCB DEVICES
Site of measurement
Number of measurements
Calibration
Phototherapy
Drager JM103 BiliCheck
BiliEclipse
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10. CLINICAL APPROACH
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JAUNDIC
E
TERM
PRETER
M
HEMOLYS
IS
Rh/ABO Incompatability
Onset within 24 hours
Pallor
HSM
Hemolysis on PS
Increased RC (>8%)
Rapid rise in SBRSICK
Lethargy
Poor feeding
FTT
Apnea/ temperature instability
DIRECT
Dark yellow urine
Pale coloured stool
BIND
14. RECOMMENDATION
Universal clinical assessment for the presence of jaundice and risk factors for severe
hyperbilirubinemia
Appropriate follow-up based upon risk assessment and the infant's age at the time of
discharge
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15. FOLLOW UP
Discharged less than 24 hours of age, follow-up by 72 hours of age
Discharged between 24 and 47.9 hours of age, follow-up by 96 hours of age
Discharged between 48 and 72 hours of age, follow-up by 120 hours of age
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25. Filtered Sunlight -window-tinting films
Double or triple phototherapy
Super (high-intensity) phototherapy
Intermittent versus continuous phototherapy
Reflecting lights
phototherapy can be discontinued when the STB
level has fallen below 13 to 14 mg/ dL
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29. REBOUND BILIRUBIN
positive Coombs test,
prematurity,
bruising and
early use of phototherapy (started in 72 hours of life)
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30. VIGINTIPHOBIA: USE OR ABUSE OF PHOTOTHERAPY
use or abuse of phototherapy
New treatment recommendations that are less aggressive
a goal of keeping STB levels below 23.4-29.2 mg/dL among healthy term infants without
hemolytic disease, with either phototherapy (treatment threshold 17.5-22 mg/dL) or
exchange transfusion (treatment threshold: 25-29 mg/Dl
Newborns with hemolytic disease should be followed more closely, and their bilirubin
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31. FOLLOW UP
SBR > 20 - / exchange transfusion – for neuro developmental outcome
Hearing assessment after discharge before 3 months
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