This document provides an overview of neonatal jaundice, including its epidemiology, pathophysiology, etiology, clinical presentation, management, and complications. Key points include:
- Neonatal jaundice is common, occurring in 50-80% of newborns, and is usually harmless. It is caused by elevated bilirubin levels in the blood.
- Jaundice can be physiological or pathological. The causes and management differ depending on whether the elevated bilirubin is conjugated or unconjugated.
- Evaluation involves clinical exam, bilirubin levels, and other tests to determine the underlying cause. Management includes phototherapy, exchange transfusion, or pharmacotherapy depending on
This presentation was done by Dr. Julius P. Kessy,MD. An intern Doctor at Dodoma Regional Referral Hospital (DRRH) during pediatrics unit clinical meeting and supervised by Dr. Christina K. Galabawa,MD,Mmed2, Pediatrics and Child Health, University of Dodoma (UDOM) in November, 2017.
Please find the power point on Phototherapy in jaundice . I tried to present it on understandable way and all the contents are reviewed by experts and from very reliable references. Thank you
This presentation was done by Dr. Julius P. Kessy,MD. An intern Doctor at Dodoma Regional Referral Hospital (DRRH) during pediatrics unit clinical meeting and supervised by Dr. Christina K. Galabawa,MD,Mmed2, Pediatrics and Child Health, University of Dodoma (UDOM) in November, 2017.
Please find the power point on Phototherapy in jaundice . I tried to present it on understandable way and all the contents are reviewed by experts and from very reliable references. Thank you
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
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Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
3. INTRODUCTION
Neonatal jaundice is the yellowish discoloration of the
eyes, skin and mucous membranes in the first month
of life due to elevated level of bilirubin in the blood
It is a common and, in most cases, harmless problem
in neonates 1,2
It may present with other symptoms like
yellowing of the palms or
dark, yellow urine – a newborn baby's urine should be
colourless
pale-coloured stool – should be yellow or orange
3
4. INTRODUCTION
The yellow discoloration may be as a result of
elevation of either the uncongugated or conjugated
bilirubin
Bilirubin may have a physiologic role as an
antioxidant but elevations of indirect, unconjugated
bilirubin are potentially neurotoxic.
Even though the conjugated form is not neurotoxic,
direct hyperbilirubinemia indicates a potentially
serious hepatic disorders or a systemic illness
Poor management can result into either death or
serious neurological problems
4
5. EPIDEMIOLOGY
Neonatal jaundice first been described in a Chinese
textbook 1000 years ago
In 1875, Orth first described yellow staining of the
brain, in a pattern later referred to by Schmorl as
kernicterus
It is extremely common because almost every
newborn develops an unconjugated serum bilirubin
level of more than 30 µmol/L (1.8 mg/dL) during the
first week of life
5
6. EPIDEMIOLOGY
Incidence varies with ethnicity and geography, higher
in East Asians and American Indians and lower in
Africans 3
Incidence is higher in populations living at high
altitudes 3
Risk of developing significant neonatal jaundice is
higher in male infants 3
Generally, the prevalence in hospital practice is
estimated at between 50-80%, being more common
in preterm (about 80%) than in term infants (about
50%). 4
6
7. TYPES OF JAUNDICE
7
• Appears after 24 hours
• Total bilirubin rises by less than 5 mg/dl per
day
• Maximum intensity by 4th-5th day in term &
7th day in preterm
• Serum level 12-15 mg / dl
• Clinically not detectable after 14 days
• Resolves without treatment
Physiological
Jaundice
• Appears within 24 hours of age
• Increase of bilirubin > 5 mg / dl / day
• Serum bilirubin > 15 mg / dl
• Jaundice persisting after 14 days
• Stool clay / white colored
• Urine staining yellow, staining clothes
• Direct bilirubin > 2 mg / dl
• Signs of underlying illness
Pathological
Jaundice
8. Cytochrome, calatases
Rate limiting step. activated by physiological stressors like
hypothermia, acidosis, hypoxia and infections.
Bound to albumin
BILIRUBIN METABOLISM
10. AETIOLOGY
10
The cause of jaundice can be either physiologic or
pathologic
Causes of physiological jaundice
1. Decreased RBC survival <90 days, increased RBC vol /Kg,
polycythemia of NB
2. Poor hepatic uptake due to immature liver - decreased ligandin
or Y- protein
3. Increased enterohepatic circulation due to
high level of intestinal beta-glucuronidase
delayed colonization by bacteria
decreased gut motility
11. AETIOLOGY
Causes of pathological jaundice
Unconjugated hyperbilirubinemia (hemolytic/non-hemolytic)
Conjugated hyperbilirubinemia (hepatic / post hepatic)
11
13. AETIOLOGY
Non hemolytic causes of pathological jaundice
(Unconjugated)
Breast milk jaundice
Criggler Najjar syndrome types I and II
Gilbert syndrome
Hypothyroidism
13
14. AETIOLOGY
Causes of Pathological jaundice (conjugated)
1. Hepatic
Idiopathic neonatal hepatitis
Dubin Johnson syndrome
Rotor’s syndrome
Infections –TORCH, sepsis
Inborn errors of metabolism (galactosemia, tyrosinemia)
2. Post hepatic
Biliary atresia
Bile duct stenosis
Choledochal cyst
14
15. AETIOLOGY
Common causes of jaundice in our environment
Physiological
Blood group incompatibility
G6PD deficiency
Breast milk jaundice
Sepsis
Cephalhematoma
15
16. CLINICAL PRESENTATION
Yellowness of the eyes or body
Fever
Vomiting
Inability to suck
Features of failure to thrive
Abdominal distention
Passage of pale stool
16
18. HISTORY
Biodata
Onset / duration /progression
Color of urine/stool
Vomiting
Feeding history
Loss of weight
Maternal history
Antenatal –booking, illnesses, infections
Drugs – sulfa, NSAIDs, herbals
Medical history – blood group, hemolytic diseases, liver disease,
recurrent jaundice
Family history – siblings with jaundice, familial jaundice, liver disease
Birth history – trauma, cord clamping 18
19. EXAMINATION
Examine for jaundice (bright yellow/orange or
greenish/muddy yellow)
Jaundice usually becomes apparent in a cephalocaudal
progression, starting on the face and progressing to the
abdomen and then the feet, as serum levels increase.
Kramer’s Index
1. Face-4-6 mg/dl
2. Chest &Upper trunk – 8-10 mg/dl
3. Lower abdomen,thigh-12 -14mg/dl
4. Forearms &lower legs -15 -18 mg/dl
5. Palms & sloes->15-20 mg/dl
19
20. EXAMINATION
Pallor
Dehydration
Weight loss
Fever or hypothermia
Hepato/splenomegaly
Evidence of birth trauma or injuries
Evidence of Kernicterus
20
21. INVESTIGATIONS
Bilirubin measurement
Serum (total and direct)
Transcutaneous (bilirubinometer/icterometer) 5
Full blood count and blood smear
Hemoglobin concentration
Reticulocyte count
Blood group
Coombs test
Urinalysis – reducing substances
urine m/c/s
Electrolyte, urea and creatinine
Liver function test (AST/ALT, ALP/GGT)
21
23. TRANSCUTANEOUS
MEASUREMENT OF BILIRUBIN
Eligibility of babies for TcB estimation:
1. Babies ≥ 38 week gestation visibly jaundiced after 24 hrs of
age until 14 days
2. Babies 34 – 37+6 weeks gestation who are ≥ 72 hrs old until
14 days
3. Babies not on phototherapy
Contraindications
1. Infants with pathological Jaundice
2. Babies less than 24 hrs old
3. Babies on phototherapy or undergone phototherapy /exchange
transfusion
23
25. JAUNDICE ASSOCIATED WITH
BREAST-FEEDING
25
Breast milk jaundice Breastfeeding jaundice
2% of breastfed infants 13% of breastfed infants
Occurs after 7th day Occurs within 1 week
Max may be up to10-30mg/dl May reach >12mg/dl
Peaks at 2-3 weeks
SB falls gradually if breastfeeding
stops
Responds to phototherapy Responds to frequent
breastfeeding
Aetiology not clear
Associated with glucuronidase in
milk
Cause: decreased milk
intake,dehydration,reduced
caloric intake,glucose water
supplement
26. TREATMENT OF UNCONJUGATED
HYPERBILIRUBINEMIA
Aim of treatment
1. Reduce the incidence of severe hyperbilirubinaemia
2. Prevent bilirubin encephalopathy (kernicterus)
Modalities include
1. Phototherapy
2. Exchange blood transfusion
3. Pharmacotherapy
26
27. PHOTOTHERAPY (PT)
Is the use of high intensity light energy to reduce
bilirubin levels on the skin surface
Light is used in the white, blue, turquoise, and green
wavelengths
Bilirubin absorbs light maximally in the blue range
from 420-470nm 2
It is useful in the prevention and/or treatment of
moderate hyperbilirubinaemia.
When adequately delivered, should lower bilirubin by
1-2mg/dl over 4-6 hours 4
27
28. PHOTOTHERAPY
Mechanism of action - conversion of insoluble
bilirubin into soluble bilirubin
1. Structural isomerization - conv to lumirubin -rapidly
excreted in bile and urine
2. Photoisomerization – converts bilirubin (4Z,15Z) to
soluble isomers (e.g 4Z15E) without conjugation and
excreted into bile
3. Photooxidation -
28
29. PHOTOTHERAPY
Indications
TSB > 15 mg/dl in term
TSB > 12 mg/dl in preterm
TSB > 5 mg/dl within 24 hours
Adjuvant to exchange transfusion
Prophylactic PT – ELBW, bruised babies, hemolytic disease
of NB,VLBW with perinatal risk factors
Contraindications
Porphyria
Conjugated hyperbilirubinaemia – Bronze baby syndrome
Unconjugated hyperbilirubinaemia (20mg/dl or >)
Diseases with hypersensitivity to light
29
30. PHOTOTHERAPY
Procedure/precautions
Distance from skin – 45cm , Intensive PT – 15-20 cm
Space of 5-8cm between phototherapy unit & incubator
Double surface PT – can be given by fiber-optic blankets
(biliblankets)
Distant child from other not needing PT
Cover the eyes and Genitals
Change position once in every 2-4 hrs
Level to be checked every 10-20 hrs
Frequent temperature monitoring
Supplemental hydration(10-25ml/kg/day)
Daily weight check
Watch for side effects
30
31. PHOTOTHERAPY
Complications
31
Early Late
Loose stools Skin malignancy
Dehydration Damage to DNA
Skin rashes Patent ductus arteriosus
Hyperpigmentation Gonadal damage
Upsets maternal infant
interactions (bond)
Retinal damage
Hyperthermia Disturbance of circadian rhythm
Bronze baby syndrome
32. EXCHANGE BLOOD
TRANSFUSION (EBT)
Done to rapidly lower the serum bilirubin concentration
and/or prevent further rise
Indications
Unconjugated hyperbilirubinemia of 20mg/dl and above in term
or 15mg/dl and above LBW in preterm
Serum bilirubin level up to 10mg/kg for other preterms
Bilirubin level rising rapidly up to 5mg/dl/day
Serum bilirubin >10mg/dl on the first day of life or 15mg/dl at
48hrs of life
Clinical signs of kernicterus
Others - severe anaemia, DIC
32
33. EXCHANGE BLOOD
TRANSFUSION
Technique – commonly “push-pull” method using
umbilical vein catheter
Choice of blood – heparinized, fresh whole blood
preferred (also used – ACD or CPD can also be used)
Quantity – twice the blood volume of the patient
(160-170ml/kg), over 60-90min.
Blood is exchanged in aliquots of 5,10 or 20ml, or
smaller volumes for small infants
Priming the infant by infusion of 1 mg/kg of salt-poor
albumin a few hours before EBT increases efficiency
33
34. EXCHANGE BLOOD
TRANSFUSION
Procedure
Take vital signs
Empty the stomach – prevents aspiration
Ensure right blood is available
Maintain asepsis
Catheterize umbilical vein and secure in place
Take pre EBT PCV and serum bilirubin
Exchange blood in aliquots and document
Give 1ml of 10%calcium gluconate after every 100ml slowly
and listen to the heart alongside
Take post EBT PCV and serum bilirubin
Replace all drugs given earlier if not time for next dose
Prevent hypoglycaemia – 200mg/kg of IV glucose
Adjuvant phototherapy
34
35. EXCHANGE BLOOD
TRANSFUSION
Complications of EBT
Complications of catheterization
Gut perforation and peritonitis
Wrong position of tip of catheter (may excite cardiac
arrhythmia if in the right atrium)
Necrotizing enterocolitis
Liver cirrhosis (long-term complications)
Complications of blood transfusion
Transmission of infection (malaria, hepatitis B, HIV)
Transfusion reactions (immediate and delayed)
Thromboembolism.
35
36. EXCHANGE BLOOD
TRANSFUSION
Complications EBT itself
Haemodynamic changes following the push-pull process
(hypovolaemia, hypervolaemia)
Electrolyte changes (hyperkalaemia, hypocalcaemia,
hypomagnesaemia
Acid/base imbalance
Changes in cerebral blood flow.
36
37. PHARMACOTHERAPY
Not routine used because of ineffectiveness
Phenobartitone
augments hepatic uptake of bilirubin and increases the
activity of glucuronyl-transferase (UDPG-T) enzyme
Takes 48-72 hrs to reach therapeutic level
Dose 5-8mg/kg/day
Side effect – sedates, difficult to assess baby
Useful in Criggler Najar disease
37
38. PHARMACOTHERAPY
Metalloprotoporphyrins (eg tin mesoporphirin)
are competitive inhibitors of heme oxygenase
Experimental – showing prospects
Oral agar (e.g Cholesteramine)
Decreases enterohepatic circulation
Albumin infusion
Increases albumin binding to bilirubin for easy transport
Intravenous immunoglobulin
Used for infants with Rh or ABO isoimmunization
Inhibits haemolysis
Dose = 0.5-1 gm/kg/dose IV, repeat in 12hrs
38
39. KERNICTERUS
Is the pathologic diagnosis referring to the yellow
staining of the brain caused by bilirubin deposition
associated with neuronal necrosis and gliosis
It is a direct consequence of very high level of
unconjugated bilirubin
The parts of the brain commonly affected
Basal ganglia
Brain stem nuclei
Cerebellar neclei
Hippocampus
Anterior horn cells of the spinal cord
39
40. KERNICTERUS
By pathologic criteria, it develops in 30% of infants (all
gestational ages) with untreated hemolytic disease and
bilirubin levels >25-30 mg/dL 2
Overt neurologic signs have a grave prognosis
More than 75% of infants die, and 80% of affected
survivors have bilateral choreoathetosis with involuntary
muscle spasms
40
41. KERNICTERUS
It manifests clinically as acute or chronic encephalopathy
The acute is characterized by 3 phases
PHASE 1: hypotonia, lethargy, high pitched cry and poor suck,
loss of Moro reflex (D1-3)
PHASE 2: hypertonia, opisthotonus, rigidity, oculogyric crisis,
retrocollis, fever, seizures. (middle of first week). Those who
survive develop chronic bilirubin encephalopathy
PHASE 3: Hypotonia replaces hypertonia after first week
41
42. KERNICTERUS
Chronic encephalopathy manifests as
1st year
hypotonia,
active deep tendon reflexes,
obligatory tonic neck reflexes,
delayed motor skills
After 1st yr:
movement disorders (choreoathetosis, ballismus, tremor),
upward gaze,
sensorineural hearing loss
42
43. KERNICTERUS
Treatment:
Treatment of hyperbilirubinaemia
Counselling/training the parents on coping with the
sequale
Management of feeding difficulty
Physiotherapy for limitation of disability
Speech and language therapy (SALT)
Follow up appointments
43
44. TREATMENT OF CONJUGATED
HYPERBILIRUBINAEMIA
Mainly supportive
Parenteral vitamin k
Vitamin A and D supplementation – prevents rickets
Diet – low fat, medium chain triglyceride
Phenobarbitone – helps bile exceretion
Surgery may be needed (not usually in the neonatal
period)
44
45. PREVENTION
This entails prevention of neonatal jaundice,
treatment and prevention of its complications when it
occurs
Follows the three levels of prevention
1. Health promotion (primary)- educate the masses about it
and how to prevent, lifestyle modification
2. Specific protection(primary)- identify risks and institute
preventive measures
3. Early diagnosis and adequate treatment (secondary) –
identify and treat jaundice promptly
4. Limitation of disability (tertiary) - physiotherapy
5. Rehabilitation (tertiary) – integration of the baby and the
mother into the community 45
46. SUMMARY
Jaundice presents with yellowness of the skin and
mucous membranes
The cause can be physiological or pathological due to
abnormalities in bilirubin metabolism
Unconjugated bilirubin is neurotoxic to the brain and
hence needs urgent attention
Prompt diagnosis and management helps to prevent
severity and complications like kernicterus
Modalities of treatment include phototherapy, EBT
and pharmacotherapy
46
47. CONCLUSION
Neonatal jaundice still contributes significantly to
neonatal morbidity, mortality and long-term handicap
especially in the developing countries. This is made
worse by ignorance on the part of parents and health
workers which contributes to delay in seeking proper
medical care.
However, education at Primary Health Care level,
prompt diagnosis and referral to appropriate specialist
will go a long way to prevent the jaundice-associated
problems early so that death is averted and the child
will have a good quality of life. 47
48. REFERENCES
1. https://www.nhs.uk/conditions/jaundice-newborn/HS. Accessed on
26/2/2018
2. Kliegman, Robert, Richard E. Behrman, and Waldo E. Nelson. Nelson
textbook of pediatrics. 20th edition (2016).
3. https://emedicine.medscape.com/article/974786-overview#a6.
Accessed on 26/2/2018
4. Azubuike JC, Nkanginieme KE. Paediatrics and child health in a tropical
region. 2nd edition. African Educational Services;. Pp 163-170
5. Krishnasamy M, Bakri R, Bilirubinometer t. Non-invasive, hand held
transcutaneous bilirubinometer. Health Technology Assessment Section,
Medical Development Division Ministry of Health Malaysia. 2009
6. Kaplana M. Neonatal jaundice. Manipal Teaching Hospital. Powerpoint
presentation. Accessible online at: www.slideshare.net
7. Ogunlesi TA, Ogunfowora OB. Predictors of acute bilirubin
encephalopathy among Nigerian term babies with moderate-to severe
hyperbilirubinaemia. J Trop Pediatr 2011;57:80–6.
8. Ogunfowora OB. Neonatal Jaundice. OOUTH Sagamu. 2009
48