Neonatal jaundice is a yellowish discoloration of the skin due to high bilirubin levels in newborns. Nearly 60% of term newborns experience jaundice in the first week of life. High bilirubin levels can be toxic to the developing brain. Jaundice is caused by physiological or pathological factors like blood incompatibilities or liver diseases. It is important to monitor bilirubin levels closely in newborns as severe jaundice can lead to kernicterus, a neurological condition causing cerebral palsy or hearing loss.

1. Neonatal Jaundice
Meru Yale

2. Neonatal Jaundice
 Jaundice – yellowish discoloration of skin,mucous membrane and
conjunctiva due to excess accumulation of bile pigments in the
blood.
 Nearly 60% of term newborn becomes visibly jaundiced in the first
week of life.
 High bilirubin levels may be toxic to the developing CNS.
 Newborn appears jaundiced when bilirubin is >7mg/dL

3. Causes of jaundice

4. Etiology based on time of appearance
First 24 hrs of life
 - Hemolytic disease (Rh, ABO)
 - G6PD deficiency
 - RBC membrane defect (Hereditary Spherocytosis, others)
 - Large amount of medications to mother – Vit.K, Salicylate
 - Intrauterine infections
 - Crigler - Najjar Syndrome
24hrs to 72hrs
 -Physiological jaundice

5. After 72 hrs of life
 - Septicemia
 - Neonatal hepatitis
 - Biliary atresia
 - Metabolic disease (Galactosemia, alpha-1- antitrypsin def.)
 - Intestinal obstruction
 - Hypothyroidism
 - Breast milk Jaundice
Jaundice beyond 14 days is persistant jaundice

6. Physiological Jaundice
 Infants develop visible jaundice due to of unconjugated bilirubin.
 Appears between 24-72hrs.
 Total serum bilirubin level peaks by 3 days of age then falls in term
neonates.

7. Physiological Jaundice
 Low activity of enzyme glucuronosyltransferase.
 Shorter lifespan of fetal RBC ,80-90days.
 Low conversion of bilirubin to urobilinogen by intestinal flora
 high absorption of bilirubin back into circulation.

8. Pathological Jaundice
 Elevation of TSB level to an extent where treatment of jaundice is likely to
result into benefit than harm.
 TSB level >5mg/dl on first day
 >10mg/dl on second day
 >15mg/dl thereafter in term newborns.
 Conjugated bilirubin > 2 mg / dl
 Jaundice persisting >1 wk in term or > 2 wks in preterm baby

9. Prolonged jaundice
 Persistence of significant jaundice(10 mg/dl) in a term baby beyond 3
weeks .
causes
 inadequate feeding
 breast milk jaundice
 cephalohaematoma
 hemolytic disease
 G6PD deficiency
 hypothyroidism

10. Approach
History
 Previous sibling with jaundice ,
anaemia splenectomy
 Maternal illness with fever and
rash
 Labour and delivery events
 Maternal drugs
 Liver disease in the family
 Rh/ABO Incompatibility, G6PD
deficiency, crigler – Najjar
Syndrome
 Intrauterine infection
 Asphyxia, trauma, oxytocin,
delayed cord clamping
 Sulfonamide, nitrofurantoin,
antimalarials lead to hemolysis.
 α - 1 antitrypsin deficiency, cystic
fibrosis, Galactosemia

11. Examination
 Small for date
 Microcephaly
 Pallor
 Bruises, cephalhematoma
 Petechiae
 Polycythemia
Intrauterine infection
 Intrauterine infection
 Hemolysis, bleeding
 bilirubin load
 I.U. infection,
 sepsis,
 Erythroblastosis

12.  Hepatosplenomegaly
 Omphalitis
 Chorioretinitis
 Urine staining
 clay stool
 Hemolytic anemia, I.U.
 infection, liver disease
 Sepsis
 I.U. infection
 Cholestasis

13. Clinical Estimation
 Described by Kramer
 Dermal staining of bilirubin – clinical guide for level of jaundice.
 Dermal staining progresses in cephalocaudal direction.
1-Face 4-6 mg / dl
2-Chest 6-8mg / dl
3-Lower abd/thigh 8-12mg / dl
4-Legs 12-14 mg / dl
5-Soles / palms > 15 mg / dl
 Yellow staining of palms and soles is a danger sign.

14. Kernicterus
Dyskinetic/Athetoid CP

15. Clinical features of Kernicterus
Stage I – Lethargy
irritability
vomiting
poor feeding
hypotonia
poor Moro’s reflex
muscular spasms/opisthotonus

16.  Stage II – convulsions
rigidity(opisthotonus)
loss of deep tendon reflexes
no spontaneous movements
poor feeding
bulging fontanel
high-pitched shrill cry
 Most of the infants die during this stage

17.  Stage III – stage of apparent recovery in infants who survive beyond stage II
spasticity and convulsions decrease.
a few involuntary movements may occur.

18.  Stage IV- Stage of established choreoathetoid CP
usually apparent after 3-4 years of age.
-involuntary movements with intermittent muscular spasms
convulsions
deafness
loss of upward conjugate movements of the eyes
Dysarthria
Mental retardation
dental dysplasia(yellowish-black teeth)

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