Neonatal hyperbilirubinemia

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features of hyperbilirubinemia ,differential diagnosis ,management

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Neonatal hyperbilirubinemia

  1. 1. Prof. Saad Sal-Ani Senior Pediatric Consultant Head Of Pediatric department Khorfakkan Hospital Notes on Neonatal Hyperbilirubinemia
  2. 8. Copyright ©2004 American Academy of Pediatrics Subcommittee on Hyperbilirubinemia, Pediatrics 2004;114:297-316 Guidelines for phototherapy in hospitalized infants of 35 or more weeks' gestation
  3. 9. ASSESSING THE RISK OF JAUNDICE BY THE NUMBERS <ul><li>Bhutani curve </li></ul>
  4. 10. KERNICTERUS <ul><li>Why we care about indirect hyperbilirubinemia </li></ul><ul><li>Staining of the brain by bilirubin </li></ul><ul><li>Early symptoms-acute bilirubin encephalopathy-poor feeding, abnormal cry, hypotonia, </li></ul><ul><li>Intermediate phase-stupor, irritability, hypertonia </li></ul><ul><li>Late – shrill cry, no feeding, opisthotonus, apnea, seizures, coma, death </li></ul>
  5. 11. KERNICTERUS <ul><li>Late sequelae can include </li></ul><ul><li>gaze abnormalities </li></ul><ul><li>feeding difficulties </li></ul><ul><li>dystonia </li></ul><ul><li>incoordination </li></ul><ul><li>choreoathetosis </li></ul><ul><li>sensorineural hearing loss </li></ul><ul><li>painful muscle spasms </li></ul>
  6. 12. RISK FACTORS FOR SIGNIFICANT JAUNDICE <ul><li>Gestational Age </li></ul><ul><li>Race </li></ul><ul><li>Family history of jaundice requiring phototherapy </li></ul><ul><li>Hemolysis (ABO or other) </li></ul><ul><li>Severe bruising </li></ul><ul><li>Breastfeeding </li></ul>
  7. 13. RISK FACTORS-RACE <ul><li>Asians-highest risk </li></ul><ul><li>Levels peak at 16-18 as opposed to average Caucasian levels of 6-8. There is also a later peak which can occur at 5-7 days. </li></ul><ul><li>Black infants have a lower peak, rarely exceeding 12. (but they have a much higher incidence of G6PD deficiency) </li></ul><ul><li>Caucasians are in the middle. </li></ul>
  8. 14. RISK FACTORS-GESTATIONAL AGE <ul><li>The younger the gestation, the higher the risk of jaundice. </li></ul><ul><li>37 weeks more prone to jaundice than 40 weeker who is more prone than a 42 weeker. </li></ul><ul><li>35 and below is much more prone </li></ul><ul><li>Extreme preemies also more prone to kernicterus and are treated at much lower levels. </li></ul>
  9. 15. RISK FACTORS-FAMILY HX <ul><li>A child whose sibling needed phototherapy is 12 times more likely to also have significant jaundice. </li></ul><ul><li>Frequently peak bilirubin levels correlate between siblings. </li></ul>
  10. 16. RISK FACTORS-HEMOLYSIS <ul><li>ABO Incompatibility is the most common cause of hemolysis causing jaundice. </li></ul><ul><li>Only 10-20% of infants with ABO mismatch develop significant jaundice. </li></ul><ul><li>Some of these infants, however, develop very significant jaundice quickly. </li></ul><ul><li>Coombs positive ABO is more likely to cause hemolysis, but many babies will be asymptomatic. Conversely, Coombs negative ABO mismatch does occasionally cause significant hemolysis, but this is rather rare. </li></ul>
  11. 17. RISK FACTORS-PATHOLOGIC <ul><li>G6PD Deficiency </li></ul><ul><li>Hereditary Spherocytosis </li></ul><ul><li>Glucuronyl Transferase Deficiency Type 1 (Crigler Najar Syndrome) </li></ul><ul><li>GT deficiency Type 2 (Arias Syndrome) </li></ul><ul><li>Polycythemia </li></ul>
  12. 18. Thank you

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