Neonatal jaundice is common, affecting 60% of term and 80% of preterm infants. It can signal illness but may also cause neurological damage if bilirubin levels are too high. Jaundice is either physiological, appearing after 24-72 hours and resolving by 2 weeks, or pathological, appearing within 24 hours with rapidly rising bilirubin or lasting over 2 weeks. Pathological jaundice requires treatment while physiological jaundice needs monitoring. Breast milk jaundice causes mild jaundice persisting up to 3 months. Conditions like Rh and ABO incompatibility can cause pathological jaundice through hemolysis. Very high unconjugated bilirubin levels can cross the blood

1. Neonatal jaundice

2. Objectives
• Introduction
• Defining hyperbilirubinaemia
• Bilirubin metabolism
• Physiological jaundice –causes and features
• Pathological jaundice –causes and features
• Evaluation of clinical jaundice
• Breast feeding and breast milk jaundice
• Important causes like Rh and ABO incompatibility
• Kernicterus

3. Introduction
• Almost 60 % of term and 80 % of preterm
neonates experience visible jaundice in
the neonatal period.
• 5- 10% have clinically significant jaundice
requiring treatment
• Might signal a sometimes serious yet
potentially treatable illness
• May cause serious neurological damage
(kernicterus) if levels are sufficiently high

4. Bilirubin metabolism

5. Defining hyperbilirunaemia
• Yellowish discoloration of skin and sclera
• Two types- physiological and pathological

6. Physiological
hyperbilirubinaemia
Features
Appears between 24 -72 hrs
Maximum intensity 3rd-5th
day-term,7th
day-
preterm
Does not rise more than 15 mg / dl
Does not persist for more than 2 weeks in
term and 3 weeks in preterm;clinically
undetectable by 14 days
No treatment required though should be
monitored for worsening

7. Causes of physiological
jaundice

8. Pathological jaundice
Features
Appears within 24 hrs of life
Rate of increase of
bilirubin:0.5mg/dl/hr(nnf)(0.2mg/dl/hr-
cloherty) or >5mg /dl/day
Level of bilirubin >15 mg /dl
Evidence of conjugated bilirubinaemia-
clay colored or deep yellow colored urine
 persists for >2weeks in term and >
3weeks in preterm

9. Causes

10. Evaluation of jaundice
• Cause of jaundice acc. To period of onset

11. Breast feeding jaundice
• Increased frequency of jaundice in breast
fed infants (starts from day 3 of life,mild
clinical jaundice presisting till 2-3 mnths of
life)
• Due to inadequacy of breast feeding
• t/t –ensuring optimum breastfeeding

12. Breast milk jaundice
• Jaundice more than 10mg/dl in breast fed
infants beyond 3rd
to 4th
wk of life
• To be considered when _unconjugated
_other causes of prolonged jaundice have
been ruled out(do not cease breast
feeding for either diagnosis or treatment)
• t/t –continue breast feeding
May require phototherapy
• tSB levels usually decline with time

13. Rh incompatibilty

14. Abo incompatibilty
In mothers of blood group O
With babies of A or B blood group
In case of significant hemolysis which
is usually rare,there is positive DCT
and spherocytes(not correctable with
glucose)

15. Kernicterus
• Pathophysiology :Unbound (unconjugated) bilirubin is:
– neurotoxic at high levels
– lipophilic and can cross the blood-brain-barrier

16. Kernicterus