This document discusses neonatal jaundice and hyperbilirubinemia. It begins by stating that jaundice is common in newborns, with 60% of term and 80% of preterm infants developing jaundice in the first week of life. Around 10% require treatment as high bilirubin levels can be toxic to the brain. The document then covers bilirubin metabolism, physiological jaundice, clinical quantification of jaundice, risk factors, clinical approach, investigations, phototherapy, exchange transfusion and treatment recommendations.

1. NEONATAL HYPERBILIRUBINEMIA
DR PETER R M.D. (PAED), D.M.(NEO)
ASST. PROFESSOR NEONATOLOGY
THANJAVUR MEDICAL COLLEGE

2. INTRODUCTION
 Neonatal jaundice is the common clinical sign that has been
encountered among newborn babies
 60% of term and 80% of preterm neonates develop jaundice
during first week of life
 Around 10% needs treatment
 High Bilirubin level toxic to brain- Acute Bilirubin Encephalopathy/
Kernicterus
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3. BILIRUBIN METABOLISM
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5. PHYSIOLOGICAL JAUNDICE
Breast feeding Jaundice
 Usually appears between 24-72 hrs
 Peak by 5-15 days- resolve by 3 weeks
 1/3 persist beyond 3 week -3 months
 Inadequate feeding
 Ensuring optimum feeding
Breast milk Jaundice
 2-4 %- 3-4 week of life(> 10mg%)
 Diagnosis of exclusion
 Some baby needs treatment
 No need to stop breast feeding
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6. CLINICAL QUANTIFICATION- KRAMER INDEX
 High bilirubin
 After phototherapy
 Inexperienced observer
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4-6 mg
6-8 mg
8-12 mg
12-15
mg
>15 mg
TcB –Transcutaneous Bilirubinometer

7. TCB DEVICES
 Site of measurement
 Number of measurements
 Calibration
 Phototherapy
Drager JM103 BiliCheck
BiliEclipse
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8. ETCO
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9. RISK FOR JAUNDICE
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10. CLINICAL APPROACH
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JAUNDIC
E
TERM
PRETER
M
HEMOLYS
IS
Rh/ABO Incompatability
Onset within 24 hours
Pallor
HSM
Hemolysis on PS
Increased RC (>8%)
Rapid rise in SBRSICK
Lethargy
Poor feeding
FTT
Apnea/ temperature instability
DIRECT
Dark yellow urine
Pale coloured stool
BIND

11. BIND – BILIRUBIN INDUCED NEUROLOGICAL DYSFUNCTION
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13. CAUSES
<24 Hrs 24-72 Hrs >72 Hrs >1 week(direct) Indirect
Hemolytic Disease of
Newborn
TORCH Infection
Enzyme Defieciency
Physiological
Sepsis
Polycythemia
Concealed Hges
Increased
Enterohepatic
Circulation
Sepsis
Syphilis
Toxoplasmos
is
Hepatitis
Biliary Atresia
Breast Milk
Jaundice
IEM
Criggler Najjar
Syndro
Breast Milk
Jaundice
Hypothyroidism
Pyloric Stenosis
Ongoing Hemolysis
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14. RECOMMENDATION
 Universal clinical assessment for the presence of jaundice and risk factors for severe
hyperbilirubinemia
 Appropriate follow-up based upon risk assessment and the infant's age at the time of
discharge
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15. FOLLOW UP
 Discharged less than 24 hours of age, follow-up by 72 hours of age
 Discharged between 24 and 47.9 hours of age, follow-up by 96 hours of age
 Discharged between 48 and 72 hours of age, follow-up by 120 hours of age
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16. INVESTIGATIONS
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CLINICAL
TcB
Serum Bilirubin

17. BHUTANI PREDICTION NOMOGRAM
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18. PHOTOTHERAPY
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19. EXCHANGE TRANSFUSION
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20. PRETERM NEONATES
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21. TREATMENT
 PHOTOTHERAPY
 EXCHANGE TRANSFUSION
 PHARMCOLOGICAL MANAGEMENT
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22. PHOTOTHERAPY
 Undress the Baby
 Cover genitalia and eyes
 Distance 30-45cm
 Turn the baby every feed or 2 hours
 Ensure adequate feeding
 Monitor every 12-24 hours
 Rebound after 24 hours
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23. PHOTOTHERAPY
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24. SIDE EFFECTS
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25.  Filtered Sunlight -window-tinting films
 Double or triple phototherapy
 Super (high-intensity) phototherapy
 Intermittent versus continuous phototherapy
 Reflecting lights
 phototherapy can be discontinued when the STB
level has fallen below 13 to 14 mg/ dL
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26. EXCHANGE TRANSFUSION
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Double Volume Exchange =2xBlood Volume (80-
100ml)x Birth Weight

27. PHARMACOLOGICAL TREATMENT
 Phenobarbitone
 High Dose Intravenous Immunoglobulin- 500-1000 mg/kg slow over 2 hours
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28. FLUID THERAPY
50ml/kg(N/5)+20ml/kg+1/2 of 8 Hr maintenance for 8 hours
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29. REBOUND BILIRUBIN
 positive Coombs test,
 prematurity,
 bruising and
 early use of phototherapy (started in 72 hours of life)
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30. VIGINTIPHOBIA: USE OR ABUSE OF PHOTOTHERAPY
 use or abuse of phototherapy
 New treatment recommendations that are less aggressive
 a goal of keeping STB levels below 23.4-29.2 mg/dL among healthy term infants without
hemolytic disease, with either phototherapy (treatment threshold 17.5-22 mg/dL) or
exchange transfusion (treatment threshold: 25-29 mg/Dl
 Newborns with hemolytic disease should be followed more closely, and their bilirubin
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31. FOLLOW UP
 SBR > 20 - / exchange transfusion – for neuro developmental outcome
 Hearing assessment after discharge before 3 months
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32. THANK YOU
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