This document defines neonatal jaundice and outlines its causes and management. Physiological jaundice occurs in 60% of term and 80% of preterm babies and is caused by an imbalance between bilirubin production and excretion. Pathological jaundice appears within 24 hours and is investigated and treated. Management includes phototherapy to reduce bilirubin levels or exchange transfusion for severe cases. The document discusses evaluating jaundiced babies and monitoring bilirubin levels, feeding, and hydration.

1. JAUNDICE
DR MUG,OMBA

2. objectives
• By the end of the lesson, learners must be
able to;
– Define neonatal jaundice
– Outline causes of jaundice
– Outline management of physiological jaundice
– Relate neonatal jaundice to clinical practice

3. definition
• Visible form of bilirubinemia
– Newborn skin > 5mg/dl
• Occurs in 60% of term and 80% of preterm
neonates
• However, significant jaundice occurs in 6%
of term babies

4. Clinical assessment of jaundice
• Area of body bilirubin levels in mg/dl
face 4-8
upper trunk 5-12
lower trunk 8-16
and thighs
arms and lower 11-18
limbs
palms and soles >15

5. PHYSIOLOGICAL JAUNDICE
• Characteristics
– Appears after 24 hours
– Maximum intensity by 4-5th day in term and 7th
day in preterm
– Serum levels less than 15mg/dl
– Clinically not detectable after 14 days
– Disappears without treatment
Note: Baby should, however be watched for
worsening jaundice

6. Why does physiological jaundice develop?
• Increased bilirubin load
• Defective uptake from plasma
• Defective conjugation
• Decreased excretion
• Increased entero-hepatic circulation

7. Pathological jaundice
• Appears within 24 hours of age
• Increase of bilirubin > 5mg/dl/day
• Serum bilirubin > 15mg/dl
• Jaundice persisting after 14 days
• Stool clay/white coloured and urine
staining clothes yellow
• Direct bilirubin >2mg/dl

8. Causes of jaundice
• Appearing within 24 hours of age
– Haemolytic disease of new born Rh, AOB
– Infections; TORCH, malaria, bacterial
– G6PD deficiency
TORCH syndrome refers to infection of
developing foetus or newborn. TORCH stands
for Toxoplasmosis, Other agents, Rubella,
Cytomegalo viruses, and Herpes simplex

9. Appearing between 24-72 hours of life
• Physiological
• Sepsis
• Polycythemia
• Concealed haemorrhage
• Intraventricular haemorrhage
• Increased entero-hepatic circulation

10. After 72 hours of age
• Sepsis
• Cephalhaematoma
• Neonatal hepatitis
• Extra hepatic biliary atresia
• Breast milk jaundice
• Metabolic disorders

11. • Breast milk jaundice is a type of jaundice
associated with breast feeding
• Occurs one week afterbirth and can
sometimes last for 12 weeks
• Rarely causes complications
• Cause not known

12. • However, may be linked to a substance in
in the breast milk that prevents certain
proteins in infant’s liver from breaking
down bilirubin
• Condition may also run in families

13. Risk factors for jaundice
• J- Jaundice within 24hours of life
• A- A sibling who was jaundiced as neonate
• U-Unrecognised haemolysis
• N-Non optimal sucking/nursing
• D-Deficiency of G6PD
• I- Infection
• C-Cephalhaematoma/bruising
• E- East Asian/North Indian

14. Common causes
• Physiological
• Blood group incompatibility
• G6PD deficiency
• Cephalhaematoma/bruising
• Intrauterine and postnatal infections
• Breast milk jaundice

15. Approaches to jaundiced baby
• Ascertain birth weight, gestation and post
natal age
• Assess clinical condition (well or ill)
• Decide whether jaundice physiological or
pathological
• Look for evidence of kernicterus* in deeply
jaundiced newborn
• *Lethargy and poor feeding, convulsions

16. investigations
• Maternal and perinatal history
• Physical examination
• Laboratory tests (must in all)
– Total and direct bilurubin
– Blood group and Rh for mother and baby
– Haematocrit, retic count and peripheral smear
– Sepsis screen

17. • Liver and thyroid function
• TORCH titers, liver scan when conjugated
hyperbilirubinemia

18. management
• Rationale: reduce level of bilurubin and
prevent bilurubin toxicity
• Prevention of hyperbilirubinemia; early
feeds, adequate hydration
• Reduction of bilirubin levels ; photo
therapy, exchange transfusion, drugs

19. Phototherapy equipment
• White light tubes
• Cradle or incubator
• eyeshades

20. Phototherapy technique
• Perform hand wash
• Place baby naked in cradle or incubator
• Fix eye shades
• Keep baby at least 45cm from light, using
closer monitor temperature of baby
• Start photo therapy
• Frequent breast milk feeding every 2
hours

21. • Turn baby after each feed
• Record temperature every 2 hours
• Record weight daily
• Monitor urine frequently
• Monitor bilirubin level

22. Side effects of phototherapy
• Increased sensible water loss
• Loose stools
• Skin rash
• Bronze baby syndrome
• Hyperthermia
• Upsets maternal baby interaction
• May result in hypocalcaemia

23. Choice of blood for exchange blood
transfusion
• ABO incompatibility
– Use O blood of same Rh type, ideal O cells
suspended in AB plasma
• Rh isoimmunisation
– Emergency O negative blood
– Ideal O negative suspended in AB plasma or
blood
• Other situations
– Baby’s blood group

24. Pronged indirect jaundice
• Causes
– Crigler Najja’s syndrome
– Breast milk jaundice
– Hypothyroidism
– Pyloric stenosis
– Ongoing haemolysis, malaria

25. Conjugated hyperbilirubinemia
• Suspect
– High coloured urine
– White or clay coloured stool
Caution : always refer to hospital for
investigations so that biliary atresia or
metabolic disorders can be diagnosed and
managed early

26. Causes
• Idiopathic neonatal hepatitis
• Infections- hepatitis B, TORCH. sepsis
• Biliary atresia, choledechal cyst
• Metabolic- Galactosemia, tyrosinemia,
hypothyroidism
• Total parenteral nutrition