care baby with neonatal jaundice

2. NEONATAL JAUNDICE

3. Introduction
Jaundice is the visible
manifestation of
hyperbilirubinemia. it
also termed as icterus
neonatorum. Or as neonatal
hyperbilirubinemia. Almost
60% term & 80% preterm will
Get jaundice in the first week
of life.

4. Definition
A yellow discolouration of the skin, sclera and mucous
membrane due to an increase serum bilirubin level.
This becomes clinically evident when serum bilirubin
reaches about 5 mg/dl. It can reach up to 15mg/dl also.

5. Types of neonatal jaundice
Physiological jaundice
Pathological jaundice

6. Physiological jaundice
There is elevation of unconjugated bilirubin concentration due
to various reason in the first week of life.
The possible mechanism of physiological jaundice are as follows
o Increased Bilirubin Load On Hepatic Cells
o Defective Bilirubin Conjugation
o Defective Uptake Of Bilirubin By Liver From Plasma
o Defective bilirubin excretion due to congenital infection.

7. Characteristics of physiological jaundice
 It appears in b/w 30 to 72 hrs of age in term babies & in
preterm babies may appear earlier but not before 24 hrs of
age.
 Serum bilirubin does not exceed 15mg/dl
 Usually disappears by 7th to 10th day in term babies & by 14th
day in preterm babies.
 Subsides spontaneously & no treatment is needed.
 Mother needs encouragement for exclusive breast feeding for
adequate hydration & reassurance.
 In severe can go for phototherapy
 Careful observation for s/s of complication is needed.

8. PATHOLOGICAL JAUNDICE
About 5% of neonates develops pathological jaundice.
Appearance of jaundice within 24 hours of age is always
pathological. Investigation should done to ruled out the
exact causes of pathological jaundice.

9. Causes
Excessive Destruction Of Rbc
Due To Hemolytic Diseases Of
Newborn
 Defective Conjugation Of
Bilirubin
Failure To Excrete The
Conjugated Bilirubin
 Miscellaneous
Viral Hepatitis
Malaria
Intrauterine Infection
 Anoxia etc.

10. Types of pathological jaundice
 Prolonged Unconjugated Hyperbilirubinemia
 Prolonged Conjugated Hyperbilirubinemia

11. Characteristics of pathological jaundice
Clinical jaundice appears within 24 hrs of birth & persist
more than one week in term babies more than 2 weeks in
preterm babies.
Bilirubin level is increasing by more than 5mg/dl per day or
0.5mg/dl per hour.
Total bilirubin level is more than 15mg/dl.
kernicterus ( pathological condition of the brain due to
toxicity by unconjugated bilirubin)
Palms & soles are yellow
Stool clay or white colored & urine is staining clothes.

13. Assessment
Mainly to distinguish types of jaundice
History collection
Physical exam
non invasive assessment of jaundice
Icterometer
Trancutaneous bilirubinometer.
Lab investigation:
Serum bilirubin level (Total conjugated & unconjugated)
HB
Serum albumin
RBC Morphology
Sepsis screen
Liver function test

15. I - Bilirubin quantity between 5 and 8 mg/dl.
II - Bilirubin quantity between 8 and 10 mg/dl.
III - Bilirubin quantity between 10 and 13 mg/dl.
IV - Bilirubin quantity between 13 and 16 mg/dl.
V - Bilirubin quantity around 20 mg/dl.

17. • The following are the key elements of the recommendations
provided by this guideline.
• Promote and support successful breastfeeding.
• Establish nursery protocols for the identification and evaluation of
hyperbilirubinemia.
• Measure the total serum bilirubin (TSB) or transcutaneous bilirubin
(TcB) level on infants jaundiced in the first 24 hours.
• Recognize that visual estimation of the degree of jaundice can
lead to errors, particularly in darkly pigmented infants.
• Interpret all bilirubin levels according to the infant’s age in hours.
• Recognize that infants at less than 38 weeks’ gestation,
particularly those who are breastfed, are at higher risk of
developing hyperbilirubinemia and require closer surveillance and
monitoring.

18. Management
• Perform a systematic assessment on all infants before discharge
for the risk of severe hyperbilirubinemia.
• Provide parents with written and verbal information about newborn
jaundice.
• Provide appropriate follow-up based on the time of discharge and
the risk assessment.
• Treat newborns, when indicated, with phototherapy or exchange
transfusion.

19. Management
Phototherapy
Exchange
blood transfusion (EBT)
 Drug therapy

20. Phototherapy
It is non invasive, inexpensive & easy method of degradation of
Unconjugated bilirubin by photo oxidation.

21. • https://www.youtube.com/watch?v=sjVEc8z0tuA
• https://www.youtube.com/watch?v=hGEVOtdObCE

22. https://www.youtube.com/watch?v
=hGEVOtdObCE (EBT)
It is most effective &
Reliable method for
reduction of bilirubin
level in case of severe
hyperbilirubinemia to
Prevent kernicterus &
correct anemia.
https://www.youtube.com
/watch?v=42xzmYqkjB4

23. Drug therapy
 The Drugs Have
Very Little Role
In The Treatment
Of Neonatal
Jaundice
Commonly Used
Drugs are
 Poly Vinyl
pyrrolidone.
Cholestyramine.

24. Prevention


 Administration of anti- D immunoglobulin to the Rh
negative mother
 Prevention perinatal distress
Avoidance of jaundice aggravating drugs
Treatment of sepsis & hepatitis