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
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
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
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
