This document discusses neonatal jaundice, including its definition, causes, types, clinical features, management, and complications. Some key points: - Neonatal jaundice is yellowish discoloration of skin in newborns due to high bilirubin levels, which can be toxic if not treated. - It affects 60% of term and 80% of preterm infants. There are physiological and pathological types. - Causes include an imbalance between bilirubin production and excretion by the liver. - Management involves monitoring bilirubin levels, phototherapy to reduce levels if high, and exchange transfusions in severe cases. - Complications include neurological issues if

1. NEONATAL JAUNDICE

2. o Jaundice is an important problem in the first week of life.
o High bilirubin levels may be toxic to the developing central
nervous system and it cause neurological impairments in term
newborns.
o Almost 60% term neonate and 80% preterm neonate have
bilirubin levels greater than 5mg/dl in the first week of life.
INTRODUCTION

3.  It is also called Icterus neonatrum , neonatal
hyperbilirubinemia.
 Neonatal jaundice defined as a total serum bilirubin level
above 5mg/dl.
 It refers to an excessive accumulation of unconjugate bilirubin
in blood resulting in yellowish discoloration of skin & mucous
membrane.
DEFINITION

4. Contd…..
 Bilirubin is formed from the breakdown of RBCs.
 It excreted from the body in the form of Urobilinogen
(through urine) and Stercobilinogen (through stool).
 Jaundice occurs when the liver can not excrete sufficient
bilirubin from the plasma.

6. PHYSIOLOGICAL
JAUNDICE

7. Peak level of bilirubin (>12mg/dl) is reached on 4th to 5th day
and disappears by 7-14 days.
In premature babies, maximum bilirubin level reaches
15mg/dl on 5th to 7th day & disappears by 14-28 days.
INTRODUCTION

8. CAUSES
INCREASED BILIRUBIN
LOAD ON LIVER CELLS
DEFECTIVE
BILIRUBIN
CONJUGATE
DEFECTIVE HEPATIC UPTAKE
OF BILIRUBIN FROM PLSMA
DECREASE
BILIRUBIN

9.  IN TERM BABIES: It appears between 30 to 72 hours of age .
 Intensity is found on the 4th day.
 Disappears by 7th to 10th day.
CHARACTERSTICS

10. IN PRETERM BABIES: It appears earlier but not before 24
hours of age.
Intensity is found on 6th to 7th day.
Disappears by 14th.
Serum bilirubin does not exceeds 15mg/dl.
Conti..

11. PATHOLOGICAL JAUNDICE

12.  Jaundice occurring within 24hrs.of birth is called pathological
jaundice.
 About 5% of neonates develop pathological jaundice.
INTRODUCTION

13. CAUSES

14.  Appears within 24 hrs. of birth.
 In term babies: It persist more than 1 week.
 In preterm babies: It persist more than 2 weeks.
 Bilirubin level is increasing by more than 5mg/dl per day or
0.5mg/dl per hour.
CHARACTERSTICS

15.  Total bilirubin level is more than 15mg/dl.
 Palms & soles are yellow.
 Stool clay or white colored & urine is staining clothes.
Conti…

16. Inadequacy of breast feeding.
Decreased hepatic clearance of bilirubin.
Begin at 2-4 days of age.
Occur in approx.10-25% of breast fed infants.
Appears between 24-72 hrs. of age.
Peaks by 5-15 days of life.
Disappears by 3rd week of life.
BREAST FEEDING JAUNDICE

17.  It is caused by factors in breast milk like fatty acids, pregnanediol
that inhibit conjugation or decrease excretion of bilirubin.
 Begins at the age of 5-7 days.
 Occur in 2-3% of breast feed infants.
 Peak level is seen during 2nd week of life and then gradually
diminishes.
BREAST MILK JAUNDICE

18. Yellow discoloration of
skin. Sclera or nails.
CLINICAL FEATURES

19. Lethargy.

20. Refusal to food.
Dark urine and stool.

21. • Serum bilirubin.
• Hemoglobin.
• Hematocrit value.
• Serum albumin.
• RBC morphology.
• COOMBS test.
• ABO & Rh-blood groups.
• Liver & thyroid function test etc.
DIAGNOSTIC EVALUATION

22. ASSESSMENT

23. AREA OF THE BODY RANGE OF INDIRECT
BILIRUBIN
Head and neck 4-8mg/dl
Upper trunk 5-12mg/dl
Lower trunk & thighs 8-16mg/dl
Arms & lower legs 11-18mg/dl
Palms & soles >15mg/dl
KRAMER’S CRITERIA FOR
ASSESSMENT OF JAUNDICE

24. ADMIT
o All the babies with jaundice should be admitted to special
care nursery.
HISTORY COLLECTION
o Family history of jaundice/liver disease, previous sibling
with jaundice, maternal illness during illness.
o Perinatal history such as traumatic delivery, delayed cord
clamping, birth asphyxia etc.
MANAGEMENT

25. PHYSICAL EXAMINATION
o Inspection of skin.
o Should also be examined for presence of IUGR &
cephalohematoma.
o Non- invasive Assessment
• It is done with Ingram icterometer & transcutaneous bilirubinometer.
Conti…..

26. PHOTOTHERAPY

27. o The main aim is reduction of serum bilirubin level within safe limit
& prevention of CNS toxicity.
o Non-invasive, inexpensive & easy method of degradation of
unconjugated bilirubin by photo-oxidation.
o The light waves convert toxic bilirubin into water soluble non-toxic
form which is excreted from blood in the bile,stool,urine.
INTRODUCTION

28.  RECOMMENDATION
 Started when serum bilirubin approaches 15mg/dl.
 In preterm babies, it started at serum bilirubin level of 5mg/dl or
more.
 Fluorescence or halogen lights are used.
Conti…..

29.  Technique
 Blue or white lights are used and most effective, 6-8 light sources
are used.
 Wavelength of light should be 420-600nm.
 The distance between naked infant or light sources is 45cm from the
skin of the baby.
Conti….

30.  When to stop phototherapy
 When serum bilirubin level are less than 10mg/dl for 2 times.
 Intensive phototherapy usually reduces 1to2mg/dl of serum
bilirubin within 4to6 hrs. of exposure.
Conti…

31. Infant with direct hyperbilirubinemia: Because in direct
bilirubin levels are not usually high in these conditions &
phototherapy may lead to “ Bonze Baby Syndrome”.
CONTRAINDICATION

32. IMMEDIATE PROBLEMS
 Dehydration.
 Hypothermia.
 Loose stools.
 Electric shock.
 Hyperthermia.
COMPLICATION

33. LONG TERM PROBLEMS
 Disturbance of endocrine or sexual maturation.
 Retinal damage.
 Skin cancer.
Contii..

34. o Baby’s eyes should be covered.
o Diaper to be kept on to cover the genital(specially in male baby
to prevent gonadal damage).
o Position should be changed every 2nd hrly or after each feed.
ROLE OF NURSE

35. o Temperature to be recorded 2nd hrly.
o 2nd hrly breastfeeding to be given or extra fluids to be
provided.
Contd…

36. CONTI….

37. o Baby’s weight to be recorded.
o Constant observation should be made for urine,stool,skin rashes etc.
o Serum bilirubin level to be estimate at least every 12 hours.
Conti….

38.  PHENOBARBITONE
 It promote hepatic glucuronyl transferase synthesis.
 It promote synthesis of albumin.
 METALLOPORPHYRINS
 Tin-protoporphyrin & tin-mesoporphyrin inhibit heme
oxygenase activity.
PHARMACOLOGICAL
MANAGEMENT

39. It is used when serum bilirubin levels is more than 20mg/dl
in term baby or more than 15mg/dl in preterm baby.
EXCHANGE BLOOD
TRANSFUSION

40. It also help to stop hemolysis in affected baby.
It is given when phototherapy fails to prevent a rise in
bilirubin to toxic levels.
Conti…

41. CONTI…

42. IMMEDIATE
• Cardiac failure.
• Air embolism.
• Tetany.
• Hypoglycemia.
DELAYED
• Portal vein
thrombosis.
• HIV.
• Ulcerative colitis
etc.
COMPLICATION

43. COMPLICATION
TRANSIENT
ENCEPHALOPATHY
KERNICTERUS

44. TRANSIENT ENCEPHALOPATHY

45.  It is reversible neurological complication suspected in increasing
lethargy along with bilirubin level.
TRANSIENT
ENCEPHALOPATHY

46. KERNICTERUS

47. It occurs as a result of necrosis of neurons in basal
ganglia,subthalmic nuclei.
Problems in neonates are:
Poor sucking.
Lethargy.
Fever.
High pitched cry.
Death.
KERNICTERUS