This document discusses neonatal jaundice, including its causes, assessment, management, and follow up. Key points: - Neonatal jaundice is common, seen in 60% of term and 80% of preterm infants, and is usually due to increased bilirubin production, defective conjugation, or increased enterohepatic circulation. - Assessment involves history, physical exam for signs of jaundice, sepsis, or kernicterus, and measuring serum bilirubin levels. - Management depends on bilirubin levels and underlying conditions, and may include phototherapy, antibiotics for sepsis, hydration, exchange transfusion, or albumin/immunoglobul

1. NEONATAL JAUNDICE
Mohammad Almaghayreh

2. Yellowish discoloration of the
sclera and skin in a
newborn
•Visible jaundice when
SB>85umol/L (5mg/dl)
•Start from the – face→
neck→chest→abdomen→li
ms
•Common condition
–cause morbidity and
mortality

3. Bilirubin Metabolism

4. Newborn more prone to
jaundice?
•High hemoglobin mass at birth
•Shorter fetal hemoglobin life span
•Low enzyme Glucurony ltransferase activity
(reach adult level by 14 days regardless of
gestation)
•Low concentration of ligandin Y protein (carries
unconjugated bilirubin to the smooth
endoplasmic reticulum) – increase to adult
level by 5-10 days of age

6. Why does physiological jaundice
develop?
• Increased bilirubin load
• Defective conjugation
• Increased entero-hepatic circulation
 Incidence
– Term in 60%
– Preterm 80%

8. Danger of acute severe neonatal
jaundice
•Risk of bilirubin neurotoxicity (Kernicterus)
–Unconjugated bilirubin cross blood brain barrier
toxic to deep grey matter (esp globus pallidus)
athetoid cerebral palsy &SNHL
•Higher risk of Kernicterus
–sepsis, prematurity, small for gestational age,
acidosis, asphyxia, hypoalbuminemia and
jaundice < 24 hrs of life
•The risk decreases as the baby grows older

9. Assessment
History
• Age of onset
• Previous infant with
NNJ, kernicterus,
neonatal death, G6PD
deficiency
• Mother’s blood group
• Gestational
• Presence of symptoms
suggestive of sepsis
Physical examination
• General condition,
weight, hydration
status, sign of sepsis
• Sign of kernicterus:
lethargy, hypotonia,
seizure, opisthotonus,
high pitch cry
• Pallor, plethora, SAH,
cephalhaematoma
• Sign of intra-uterine
infection: petechiea,
hepatospelnomegaly

10. Assessment
Baby looks more
jaundice than the
SB level?
• Watch out for sepsis
• Repeat SB if needed
• Sometimes occurs in
anaemic or fair baby
Baby looks less
jaundice than the
SB?
• Polycythaemic baby
• Dark baby
• If the baby is under
photo, look at the
area which is not
exposed to the light

11. Management

13. Management
Depends on the SB level and the underlying
condition
• Antibiotic coverage for unwell baby
• Phototherapy (single/double)
• Hydration if baby is dehydrated
• Exchange transfusion (ET)
• Human albumin
• AntiD immunoglobulin or pooled
immunoglobulin

14. Phototherapy
• Phototherapy lights with minimum irradiance of
15μW/cm2/nm
• Intensive photo >30μW/cm2/nm
• Photo light source 35-50cm above the top surface of
the baby
• Proper exposure
• Cover the eyes
• Turn baby 2 hourly
• Monitor temperature and hydration
• Off photo light when taking blood

18. Breastfeeding Jaundice

19. Safe to discharge?
• SB is below photo level
– The trend of the SB is important
• Can discharge the baby
– if the baby is more than 7 days old even
though the SB level is still at the photo level
but is not rising
• Remember, the role of the phototherapy is to
prevent the SB level reaches the ET level
• All babies discharge from the ward need to be
followed up at the polyclinic (1-3 days later)

20. Prolonged jaundice
• Prolonged jaundice
– Visible jaundice that persisted beyond 14 days
of life in a term baby
• 21 days in a preterm baby
• Conjugated or Unconjugated
Hyperbilirubinemia?
– Conjugated hyperbilirubinemia if conjugated
bilirubin ≥ 25 μgmol/L or >15% of total bilirubin

22. • FBC/PBF
• Coomb’s test
• Urine Culture
• FT4/TSH if not done
Other investigation
according to the
underlying cause
• γGT
• Serum bile acids level
• TORCHES
• Hep B/VDRL
• FT4/TSH
• Urine culture
• IEM if relevant (including
Galactosemia, urine for
organic acid, serum for amino
acid)
• U/S abdominal
Unconjugated hyperbilirubinemia
Conjugated
hyperbilirubinemia

23. Conjugated hyperbilirubinemia – Extrahepatic
cholestasis
• Biliary atresia
– Need early diagnosis
– Prognosis is better if surgery (Kasai operation)
done within 60 days of age
– Diagnosis
• Ultrasound
• HIDA
• OTC/liver biopsy

24. Breast milk jaundice

25. How to follow up prolonged
jaundice?
•Treat any treatable conditions
–Biliary atresia
–Hypothyroidism
–UTI
–Syphilis
–IEM

26. Follow up the baby 4-8 weekly with LFT
 •Watch out for worsening LFT/liver
cirrhosis/liver failure
 •Once investigations for prolonged jaundice
done and the SB is not increasing trend, no
need to check regular SB