A 22 month old male patient presented with loose stools, vomiting and yellowing of the skin. Laboratory tests found elevated bilirubin levels and decreased thyroid levels. The patient was diagnosed with neonatal jaundice likely caused by hypothyroidism and acute gastroenteritis. Treatment included antibiotics, antacids, antiemetics, probiotics and phototherapy to reduce bilirubin levels. The parents were advised to monitor for worsening jaundice using a bilirubin meter or skin color tests and seek medical care if additional symptoms developed.

1. CASE PRESENTATION
ON NEONATAL JAUNDICE

2. FINDINGS
• A 22 month (fully developed not pre-matured) old male patient was
admitted with the current problem of loose stools, vomiting and yellowing
of skin.
• Patient with stable vitals but elevated ( total bilirubin, direct and indirect
bilirubin ) liver function test.
• Baby without any siblings.
• Total bilirubin 19.52 mg/dl (0 – 10 mg/dl)
• Direct bilirubin 0.77 mg/dl (0 – 0.5 mg/dl)
• Indirect bilirubin 18.75 mg/dl (1 – 10 mg/dl)
• T4 andTSH level is found to be decreased with 1.67 ng/dl (2.2 5.3 ng/dl) and
0.91 uI/ml (1- 39 Ul/ml)

3. FINDINGS
Decreased :
Haemoglobin, Neutrophils, PCV, MCV, MCH, MCHC,
Increased :
WBC, Lymphocytes, Platelets
• Visual Examination : of sclera of eyes, gums – yellow colour
• Patient with known acute gastroenteritis and on medication
Enterogermma vespules PO BD * 5 days
Z and D drops PO OD 1ml * 14 days
•Hypothyroidism may cause neonatal jaundice

4. ASSESMENT
SHORT TERM GOALS:
• To reduce loose stool and vomiting
• To maintain normal bloodT4 andTSH level
LONG TERM GOALS :
• To maintain normal blood bilirubin level
• To reduce the risk due to neonatal hyperbilirubinemia ie kernicterus and bilirubin
encephalopathy
• To reduce the complication of acute gastroenteritis
Visual Examination :
Undress the baby and examines the skin under good lighting and found yellow
coloration due to unconjugated bilirubin

5. RECOMMENDATION
Sl .
No
PRESCRIBED DRUGS DOSE ROA FREQ DAY 1 DAY 2
BRAND NAME GENERIC
NAME
1 Inj.Taxim Cefotaxime 300 mg IV BD
2 Inj. Rantac Ranitidine 10 mg IV BD
3 Inj. Periset Ondansetron 1 mg IV BD
4 Enterogermina
vespules
Bacillus Clausil 40 mg PO BD
5 Z and D drops Elemental Zinc 1 ml PO OD

6. RESOLUTION
Bilirubin is formed by breakdown of RBC which cause jaundice and this
bilirubin goes to liver by albumin and is stored in bile duct and excrete through
duct.
PHOTOTHERAPY :
This treatment uses light to being down the bilirubin down the bilirubin levels,
here photooxidation occurs in which oxygen is added to bilirubin and thus it is
dissolved in water.This allows the liver to metabolise bilirubin and excrete
from body.
2 types : - (a) Conventional therapy
(b) Fibre optic therapy

7. PHARMACIST INTERVENTION
• As the baby is provided with the conventional therapy : given for 3 days with
a gap after every 3 – 4 days
oDuring gap, baby could not feed
oBaby may develop tan but it could disappear soon
oAs baby is placed under halogen lamp/ fluorescent lamp during the
procedure eyes of baby is to be covered
DRUG INTERVENTION
• Prescribed drugs are given rationally

8. MONITORING PARAMETERS
• Parent should know to use novel 2 color icterometer ( Bilistrip ) to increase
early maternal direction of jaundice
• Parent should have Bilicam application in mobile to assess neonatal
jaundice
• Can be checked by pressing over their bony, prominences of their chest,
hips, and knees to check if the jaundice is worsening
• Can be checked by pressing one finger on a baby’s forehead or nose. If skin
is jaundiced it will appear yellow when the finger is removed (called
blanching of skin)
• Infant undergoing phototherapy should drink adequate breast milk and
dehydration should be avoided
• Rush to doctor if fever, feeding difficulty, sleepy than usual, hard to wake up
and console