Jaundice

1. Neonatal jaundice
SARON AFEWORk

2. Contents
 Clinical manifestations
 Kernicterus
 Investigations
 Treatment

3. Clinical features
 History
 Family history
 Maternal history
 Infants history
Poor breast feedinding or poor calorie
intake
Vomiting
Delayed passage of meconium or
infrequent stools

4.  Physical finding
 Jaundice
 Areas of bleeding
 Hepatosplenomegaly
 Physical signs of prematurity, IUGR,
postmaturity
 Pallor
 Large infant
 Abnormal neurologic sign

5. Kernicturus
 Definition: a neurologic syndrome resulting
from the deposition of unconjugated bilirubin
in the basal ganglia and brainstem nuclei
 Pathogenesis: multifactorial
 Incidence
 Level and duration of exposure

6. Clinical manifestations
Acute form
Phase 1(1st-2nd d): poor sucking, stuper,
hypotonia, seizure
Phase 2(middle of 1st wk): hypertonia
of extensor muscles, opisthotonus,
retrocollis, fever
Phase 3(after 1 wk): hypertonia

7. Chronic form
 1st year: hypotonia, active deep
tendon reflexes, obligatory tonic neck
reflex, delayed motor skill
 After 1st year:movement
disorder(choreoathetosis,ballismus,
tremor), upward gaize, sensorineural
hearing loss

8. Prevention
1. For any neonate with jaundice within 24hrs,
serum bilirubin level should be checked
2. Follow up within 2-3d of discharge for all
neonate discharged earlier than 48hr
3. Recognize the presence of possible risk
factor
4. Never underestimate the severity of jaundice
by visual assessment
5. Early initiation of phototherapy in those with
elevated bilirubin
6. Recognize parental concern regarding
jaundice, poor feeding, lethargy

9. Investigation
 Serum biluribin levels
 CBC with differentials, reticulocyte
count and peripheral morphology
 Blood group
 Direct Coomb’s test

10.  Sepsis screen
 Liver and thyroid function test
 TORCH antibody titer
 G6PD enzyme assay
 Urine for reducing agents

11. Management
 Phototherapy
 Exchange transfusion
 Pharmacologic therapy

12. Phototherapy
 Principle
Native bilirubin 420-470nm photo isomers
of light of bilirubin
 Insoluble soluble
 Indications
 Duration of therapy

13. Complications
 Dehydration
 Loose stools
 Skin rash
 Bronze baby syndrome
 Hypothermia
 Upsets maternal baby interaction
 Eye injury

15. Exchange transfusion
 Indications
 If intensive phototherapy fails
 If the risk of kernicterus exceeds the
risk of procedure
 If signs of kernicterus are evident
 If the TSB is in the range for
exchange

16. Complications
 Hypervolemia
 Blood group incompatibility
 Electrolyte disturbance
 Infections
 Thrombocytopenia, anemia
 Necrrotizing enterocolitis
 Cardiac arrhythmias

17. Pharmacologoic therapy
 Antibiotics
 Adequate feeding
 Phenobarbitone
 Metalloporphyrins
 Intravenous immunoglobulins
 Albumin transfusions

18.  References
 Nelson text book of pediatrics, 18th ed
 Current diagnosis and treatment, pediatrics 19th ed
 Basis of pediatrics
 internet

19. THANK YOU