Bronze baby syndrome

1. Bronze baby
syndrome

2. INTRODUCTION
Bronze Baby Syndrome Intense grey-brown discoloration
of the skin, serum, and urine, especially in premature
infants; when phototherapy was used to reduce hyper-
bilirubinemia . Pre-existing hepatic disease is suspected
as a cause of the jaundice and may have prevented the
biliary excretion of the photo oxidation products of
bilirubin; their retention resulted in the bronze
discoloration

3. DEFINITION
Bronze baby syndrome is the dark grey-
brown pigmentation of skin, mucous membrane, and
urine following phototherapy. Hepatic dysfunction has to
be there for this condition to be present. We report a
neonate with dark brown pigmentation of the skin

4. CASUS & RISK FACTORS
The exact cause of the gray -brown discoloration in bronze
baby syndrome is uncertain
Premature infants
undernourished or underweight
Reduced liver (hepatic) function
Reduced kidney (renal) function
High dose of chloramphenicol

5. Pathogenesis
• Proposed mechanisms including photodestruction of
porphyrin and deposition in the skin or a deposition of a
photo-isomer of bilirubin the skin

6. Clinical manifestation
• Dark gray - brown discoloration of the entire skin surface, fading
approximately 6 weeks after stopping phototherapy
• Fussiness
• Poor feeding
• Weakness
• Vomiting
• Changes in mental status such as lethargy and less alertness
(obtundation)
• Pale appearance (pallor)

7. CONTI…
• Ashen-gray colour of the skin
• Abdominal tenderness
• Abdominal distention
• Hypotension (low blood pressure)
• Cyanosis causing blue lips, blue nails and bluish skin
• Respiratory distress
• Low body temperature

8. DIAGNOSTIC EVALUATION
oBlood tests .
oCT scan,
o abdominal X-rays, or abdominal ultrasound
oElectrocardiography (ECG) and echocardiography

9. MANAGEMENT

10. MEDICAL MANAGEMENT
PHARMACOLOGICAL MANAGEMENT
antibiotic
chloramphenicol
cephalosporin and phenobarbital

11. CONTI…
NON PHARMACOLOGICAL MANAGEMENT
Exchange Transfusion: Here, a major part of your baby’s blood
will be removed and replaced with fresh blood group matched
blood or plasma using a catheter.
Haemodialysis: With this, the toxins are removed from your
baby’s bloodstream and a balance is achieved in potassium and
sodium levels to stabilise the baby’s blood pressure
Oxygen therapy

12. PREVENTION
Ante-natal screening to detect Rh iso -immunization &
prompt administration of Anti D after first obstetric event.
Ensure adequate breast feeding.
 Educate parent about danger signs to ensure immediate
checkup.
Follow-up high risk babies( large cephalohematoma, family
history of jaundice) for 2-3 days of discharge

13. FOLLOWUP
oBabies with serum bilirubin>20 mg/dl & those
who required ET should be kept under follow-
up in high-risk clinic for neurodevelopmental
outcome.
oHearing assessment should be done at 3months
of age.

14. CONCLUSION
Bronze baby syndrome (BBS) is an extremely rare
dyschromia occurring in neonates with a raised
conjugated bilirubin level under phototherapy …