Jaundice in newborn

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Jaundice in newborn

  1. 1. JAUNDICE IN NEWBORN
  2. 2. DEFINITION YELLOWISH DISCOLORATION OF SKIN AND THE MUCOUS IS CAUSED BY ACCUMULATION OF EXCESS OF BILIRUBIN IN THE TISSUE & PLASMA (SERUM BILIRUBIN LEVEL > 7mg% )
  3. 3. CAUSES OF NEONATAL JAUNDICE  Physiological Usually appears on 2nd and 3rd day and disappears on 7th to 10th day In term infant level may be 6-8mg/dl causes: 1)Increased red cell volume and increased red cell destruction 2)transient decreased conjugation 3)Increased enterohepatic circulation 4)decreased hepatic excretion of bilirubin
  4. 4. PATHOLOGICAL • ABSOLUTE FEATURES: A) Jaundice appearing within 24 hours of pregnancy B) Unconjugated bilirubin level > 12.9mg/dl in a term infant C) Unconjugated bilirubin level >15mg/dl in a preterm infant D) Bilirubin level increasing at the rate of >5mg/dl/day E) Conjugated bilirubin > 2mg/dl F) Clinical jaundice persisting > 1 week in a term infant or 2 weeks in a preterm infant
  5. 5. 1)Excessive red cell hemolysis a)Hemolytic disease of newborn b)Sepsis c)Blood extravasation 2)Defective conjugation of bilirubin a)Congenital deficiency of GT 3)Breast milk jaundice 4)Metabolic and endocrine deficiency 5)Increased enterohepatic circulation 6)Substance and disorder that affect binding of bilirubin to albumin 7)miscellaneous CAUSES OF PATHOLOGICAL JAUNDICE
  6. 6. HYPERBILIRUBINEMIA When the bilirubin level rises more than the arbitrary cut-off point of 10 mg%,in a term infant the condition is called “hyperbilirubinemia of the newborn”. Unconjugated: Hemolytic disease due to Rh (common) or ABO (rare) incompatibility prematurity G6PD deficiency Sepsis iatrogenic drugs cephalhematoma, cretinism, etc Conjugated: Neonatal hepatitis bacterial infection TORCH infection Trisomy 18, 21
  7. 7. DIAGNOSIS OF NEONATAL HYPERBILIRUBINEMIA A.CLINICAL Sr. bilirubin >5mg/dl B.LABORATORY STUDIES a)Serum bilirubin level >12mg/dl, requires further investigation 1)Total conjugated bilirubin and unconjugated bilirubin 2)complete hemogram including reticulocyte count 3)Blood group (ABO, Rh) status 4)Direct Coombs’ test (infant) 5)Serum albumin 6) Other laboratory tests : Urine Hemoglobin electrophoresis Osmotic fragiltity Thyroid and liver function tests G6PD screening C) Radiology and Ultrasonography 5mg/dl 10mg/dl 12mg/dl 15mg/dl >15mg/dl
  8. 8. KERNICTERUS Is a pathological condition characterized by yellow staining of the brain by unconjugated bilirubin resulting in neural injury. Basal ganglia Cranial nerve nuclei Hippocampus Brain stem nuclei Ant horn cell of spinal cord Clinically characterized by lethargy, hypotonia, poor feeding and loss of neonatal reflexes Severe illness-prostration, respiratory distress and finally ohisthotonus, hyperpyrexia, convulsion, enlarged liver and spleen Rx double surface phototherapy exchange transfusion use of barbiturate
  9. 9. MANAGEMENT 1)PHOTOTHERAPY: bilirubin level > 12mg% 420-480nm DOUBLE PHOTOTHERAPY bilirubin to lumibilirubin by structural isomerization Complications: watery diarrhea, skin rashes, dehydration, bronze baby syndrome and retinal damage 2)PHARMACOLOGIC THERAPY:PHENOBARBITONE 10mg/kg on day 1 5-8mg/kg for next 4 days Prophylaxis: mother for 2 weeks prior to delivery
  10. 10. 4)EXCHANGE TRANSFUSION :Double vol exchange replaces 85% of circulating red blood cells and reduces bilirubin level; by 50% Indications; Rise in bilirubin level >1mg/dl inspite of phototherapy Rise >0.5mg/dl /hr despite phototherapy when Hb is between 11-13g/dl To improve anemia and CCF The sr. bilirubin is >12mg/dl in first 24 hours and >20 mg/dl in neonatal period Cord blood hemoglobin is <12g/dl and bilirubin level is > mg/dl Progressive anemia Nonimmune hyperbilirubinemia –two vol exchange is
  11. 11. Air Embolism Thrombosis Hypervolemia RDS Hypothermia Acidosis Infection Hyperkalemia Hypocalcemia Hypoglycemia Cardiac arrhythmias Thrombocytopenia Coagulopathy Necrotising enteritis Complications:
  12. 12. THANKYOU ...

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