This document provides information about neonatal jaundice. It begins by defining jaundice as the yellowing of skin and eyes due to high bilirubin levels. It then discusses the different types of neonatal jaundice including physiological jaundice, pathological jaundice, breast milk jaundice, and breast feeding jaundice. Risk factors, signs, management, and complications of neonatal jaundice are also outlined. The document emphasizes the importance of monitoring bilirubin levels to prevent neurological complications such as kernicterus.
Birth Injuries are the common complications of Instrumental Delivery. So intrapartum management should be done very carefully in ordered to ensure healthy and good outcome of baby.
Phototherapy in neonatal jaundice: Introduction, definition, indication, purposes, rule of thumb, lights used in phototherapy mechanism of phototherapy, techniques of phototherapy, phototherapy units, nursing care in phototherapy, short term and long term complications, nursing diagnosis in phototherapy.
neonatal hypothermia is a very emergency condition. if we identify this in early stage we can save the life of neonate. all should know about the maintaining the temperature if the neonate is in our home.
Every year more than 10 million children die in developing countries due to acute respiratory infections (mostly pneumonia), diarrhea, measles, malaria, or malnutrition - and often to a combination of these illnesses. In 1990s, the WHO, in collaboration with UNICEF and many other agencies, institutions and individuals, responded to this challenge by developing a strategy known as the Integrated Management of Childhood Illness (IMNCI).This strategy adopted in India as Integrated Management of Neonatal and Childhood Illness (IMNCI). IMNCI caters to two groups of children
• 0-2 months, referred to as young infants.
• 2 months to 5 years, referred to as children.
Hydatidiform Mole (HM) is a rare mass or growth that forms inside the uterus at the beginning of a pregnancy. It is a type of gestational trophoblastic disease (GTD).
When a normal sperm cell fertilizes one of these oocytes, the resulting embryo has only one set of chromosomes. Because the embryo has no genes from the mother, the pregnancy cannot develop normally, resulting in a hydatidiform mole.
neontal joudice is is a yellowish discoloration of the skin, sclerae, mucous membranes and nails.
Hyperbilirubinemia is a common and, in most cases, benign problem in neonates.
Birth Injuries are the common complications of Instrumental Delivery. So intrapartum management should be done very carefully in ordered to ensure healthy and good outcome of baby.
Phototherapy in neonatal jaundice: Introduction, definition, indication, purposes, rule of thumb, lights used in phototherapy mechanism of phototherapy, techniques of phototherapy, phototherapy units, nursing care in phototherapy, short term and long term complications, nursing diagnosis in phototherapy.
neonatal hypothermia is a very emergency condition. if we identify this in early stage we can save the life of neonate. all should know about the maintaining the temperature if the neonate is in our home.
Every year more than 10 million children die in developing countries due to acute respiratory infections (mostly pneumonia), diarrhea, measles, malaria, or malnutrition - and often to a combination of these illnesses. In 1990s, the WHO, in collaboration with UNICEF and many other agencies, institutions and individuals, responded to this challenge by developing a strategy known as the Integrated Management of Childhood Illness (IMNCI).This strategy adopted in India as Integrated Management of Neonatal and Childhood Illness (IMNCI). IMNCI caters to two groups of children
• 0-2 months, referred to as young infants.
• 2 months to 5 years, referred to as children.
Hydatidiform Mole (HM) is a rare mass or growth that forms inside the uterus at the beginning of a pregnancy. It is a type of gestational trophoblastic disease (GTD).
When a normal sperm cell fertilizes one of these oocytes, the resulting embryo has only one set of chromosomes. Because the embryo has no genes from the mother, the pregnancy cannot develop normally, resulting in a hydatidiform mole.
neontal joudice is is a yellowish discoloration of the skin, sclerae, mucous membranes and nails.
Hyperbilirubinemia is a common and, in most cases, benign problem in neonates.
Icterus neonatorum presentation for studentsNehaNupur8
Introduction
Definition
Metabolism and excretion of bilirubin
Causes
Symptoms
Types
Physiological jaundice
Pathological jaundice
Breast milk jaundice
Neo natal jaundice is a yellow discoloration of the white part of the eyes and skin in a newborn baby due to high bilirubin level.
Neo natal jaundice becomes apparent at serum bilirubin concentration of 5-7mg / dL.
Shoulder and trunk 8-10mg/dl
Lower body – 10-12mg/dl.
Entire body 12-15 mg /DL
Nutraceutical market, scope and growth: Herbal drug technologyLokesh Patil
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Intravital microscopy (IVM) is a powerful tool utilized to study cellular behavior over time and space in vivo. Much of our understanding of cell biology has been accomplished using various in vitro and ex vivo methods; however, these studies do not necessarily reflect the natural dynamics of biological processes. Unlike traditional cell culture or fixed tissue imaging, IVM allows for the ultra-fast high-resolution imaging of cellular processes over time and space and were studied in its natural environment. Real-time visualization of biological processes in the context of an intact organism helps maintain physiological relevance and provide insights into the progression of disease, response to treatments or developmental processes.
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Slide 1: Title Slide
Extrachromosomal Inheritance
Slide 2: Introduction to Extrachromosomal Inheritance
Definition: Extrachromosomal inheritance refers to the transmission of genetic material that is not found within the nucleus.
Key Components: Involves genes located in mitochondria, chloroplasts, and plasmids.
Slide 3: Mitochondrial Inheritance
Mitochondria: Organelles responsible for energy production.
Mitochondrial DNA (mtDNA): Circular DNA molecule found in mitochondria.
Inheritance Pattern: Maternally inherited, meaning it is passed from mothers to all their offspring.
Diseases: Examples include Leber’s hereditary optic neuropathy (LHON) and mitochondrial myopathy.
Slide 4: Chloroplast Inheritance
Chloroplasts: Organelles responsible for photosynthesis in plants.
Chloroplast DNA (cpDNA): Circular DNA molecule found in chloroplasts.
Inheritance Pattern: Often maternally inherited in most plants, but can vary in some species.
Examples: Variegation in plants, where leaf color patterns are determined by chloroplast DNA.
Slide 5: Plasmid Inheritance
Plasmids: Small, circular DNA molecules found in bacteria and some eukaryotes.
Features: Can carry antibiotic resistance genes and can be transferred between cells through processes like conjugation.
Significance: Important in biotechnology for gene cloning and genetic engineering.
Slide 6: Mechanisms of Extrachromosomal Inheritance
Non-Mendelian Patterns: Do not follow Mendel’s laws of inheritance.
Cytoplasmic Segregation: During cell division, organelles like mitochondria and chloroplasts are randomly distributed to daughter cells.
Heteroplasmy: Presence of more than one type of organellar genome within a cell, leading to variation in expression.
Slide 7: Examples of Extrachromosomal Inheritance
Four O’clock Plant (Mirabilis jalapa): Shows variegated leaves due to different cpDNA in leaf cells.
Petite Mutants in Yeast: Result from mutations in mitochondrial DNA affecting respiration.
Slide 8: Importance of Extrachromosomal Inheritance
Evolution: Provides insight into the evolution of eukaryotic cells.
Medicine: Understanding mitochondrial inheritance helps in diagnosing and treating mitochondrial diseases.
Agriculture: Chloroplast inheritance can be used in plant breeding and genetic modification.
Slide 9: Recent Research and Advances
Gene Editing: Techniques like CRISPR-Cas9 are being used to edit mitochondrial and chloroplast DNA.
Therapies: Development of mitochondrial replacement therapy (MRT) for preventing mitochondrial diseases.
Slide 10: Conclusion
Summary: Extrachromosomal inheritance involves the transmission of genetic material outside the nucleus and plays a crucial role in genetics, medicine, and biotechnology.
Future Directions: Continued research and technological advancements hold promise for new treatments and applications.
Slide 11: Questions and Discussion
Invite Audience: Open the floor for any questions or further discussion on the topic.
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2. INTRODUCTION
Jaundice is the visible manifestation of
hyperbilirubinemia .The clinical jaundice
in neonates appear on the face at a
serum bilirubin level more than 5 mg/dl,
whereas in adults ,it is diagnosed as little
as 2mg/dl.The yellowish discolouration is
first seen on the skin of face ,nasolabial
folds and tip of nose in the neonates .
3. It is detected by blanching the skin with
digital pressure in the natural light.
Neonatal jaundice is termed as icterus
neonatorum or as neonates
hyperbilirubinemia .Almost 60 percent of
term neonates and about 80 percent
preterm neonates have bilirubin >5mg/dl
in the first week of life and 6 percent of
term babies will have bilirubin levels
exceeding 15mg/dl.
4. DEFINITION
Neonatal jaundice is a
yellowing of a baby’s skin
and eyes .Neonatal
jaundice is very common
and can occur when babies
have a high level of
bilirubin ,a yellow pigment
produced during normal
breakdown of red blood
cells.
5. Physiological jaundice
Pathological jaundice
Breast milk jaundice
Breast feeding jaundice
TYPES OF NEONATAL
JAUNDICE
7. It appears in between 30 to 72 hours of age in
term babies and in preterm babies may
appear earlier but not before 24 hours of age
Maximum intensity of jaundice is found on the
4th day in term babies and 5th to 6th day in
preterm babies .
Serum bilirubin does not exceed 15mg/dl.
Usually disappears by 7th to 10th day in term
babies and by 14th day in preterm babies.
Subsides spontaneously and no treatment is
needed.
8. Mother needs arrangement
for exclusive breastfeeding
for adequate hydration
and reassurance.
Careful observation for
signs of complications along
with essential neonatal
care are important.
May aggravated by
prematurity, asphyxia,
hypothermia ,infections
and drugs.
10. Clinical jaundice appears within 24 hours of
birth and persist more than one week in
term babies and babies more than 2 weeks
in preterm babies .
Bilirubin level is increasing by more than
5mg/dl per day or 0.5mg/dl per hour.
Total bilirubin level is more than
15mg/dl(hyperbilirubinemia).
Palms and soles are yellow.
Stool clay or white colored and urine is
staining clothes.
12. Although breast milk jaundice is quite rare ,it
often causes concern in part because why it
happen is unclear .There may be differences in
the infant’s reabsorption of the bilirubin, or in the
mother’s milk. Breast milk jaundice can appear
2-5 days after birth. Bilirubin levels peak around
10-14 days but they may remain high for several
weeks ,even as much as 3 months. If the bilirubin
level continues to climb ,the baby’s health care
provider may suggesting donor breast milk or
formulae until jaundices resolves.in rare cases
,breastfeeding may be interrupted for 24 hours, in
an effort to reduce the bilirubin level.
14. Also called as “lack of breastfeeding
jaundice or starvation jaundice” this is
caused by frequent or ineffective
breastfeeding. It is result of too little
breastfeeding and therefore low caloric
bilirubin metabolism and transport. All of
this cause bilirubin levels to be higher in
the infant’s blood .Formula milk is no “cure
all” for this kind of jaundice ;the key is to
make sure your child is taking enough
calories.
17. Increased bilirubin load on hepatic cells
Defective bilirubin conjugation
Defective uptake of bilirubin
Defective bilirubin excretion
Multiple factors are responsible for the
physiological jaundice which commonly
found in both term and preterm babies.This
is elevation of unconjugated bilirubin
concentration due to various reasons in the
first week of life. The possible etiology for
physiological jaundice are as follows:-
19. Pathological jaundice also caused by :- About
5 percent of neonates develop pathological
jaundice. Appearance of jaundice within 24
hours of age is always pathological. Some
causes of this condition may appear after 72
hours, though age of appearance of jaundice
may overlap. Investigation should be done to
ruled out the exact cause of pathological
jaundice .
20. I. In severe hemolysis
II.Excessive destruction of RBCs due to
hemolytic diseases of newborn
III.Defective conjugation of bilirubin
21. IV. Failure to excrete the conjugated bilirubin
V. Miscellaneous: viral hepatitis, malaria,
intrauterine infections hypothyroidism, alpha
thalaseemia ,drug therapy (vitamin K,
salicylates)
22. Rh-immunization is also
called as
erythroblastosis fetalis ,
a major cause of severe
hyperbilirubinemia.
Rh- incompatibility
23. It occurs commonly in ‘O’ group mother and ‘A’ or ‘B’ group
fetus . it is milder than Rh – hemolytic disease and may occur
even in first born baby. The disease can be diagnosed by
examining cord blood for elevation of serum bilirubin and
presence of maternal IgG anti ‘A’ or anti ‘B’ antibodies .
Direct coomb ‘s test generally negative or weekly positive .
ABO- incompatibility
24. MINOR GROUP
INCOMPATIBILITY
: Immunization can
occur for minor
groups
incompatibility like
kidd, Duffy etc
OTHER CAUSES :
Insufficiency in
infant reabsorption
of bilirubin
Infrequent or
ineffective
breastfeeding
25.
26.
27.
28.
29.
30. Unconjugated bilirubin may penetrate brain
cells by crossing blood brain in some
circumstances and results in neurological
dysfunction and death. Bilirubin level should be
monitored to present the following
complications in neonates:-
31.
32. Transient encephalopathy:- It is reversible
neurologic complication suspected in
increasing lethargy along with rising
bilirubin levels. Recovery is possible with
prompt initiation of management and
exchange blood transfusion.
34. Kernicterus:- it is a pathological condition
of brain due to toxicity by unconjugated
bilirubin. It occurs as a result of necrosis of
neurons in basal ganglia ,hippocampal
cortex, subthalamic nuclei and cerebellum
followed by gliosis of the areas. The
cerebral cortex usually is not affected.
Other lesions include necrosis of renal
tubular cells, intestinal mucosa and
pancreatic cells which may present as GI
bleeding or hematuria.
35. OTHER MENIFESTATIONS ARE:
Poor sucking
Lethargy
Hypotonia
Poor or absent Moro reflex
Alteration of consciousness
Fever
High pitch cry
Convulsions
Twitching
Nystagmus
36.
37.
38.
39.
40.
41.
42.
43.
44.
45.
46. *Management of neonatal jaundice is aimed
of reduction of serum bilirubin level within
safe limit and prevention of CNS toxicity as
kernicterus and brain damage .The
management include:
I. Prevention of Rh-isoimmunization by anti-D
gamma globulin to RH-negative mother in case
of birth of Rh- positive baby.
II. Reduction of bilirubin level by phototherapy and
exchange blood transfusion and prevention of
bilirubinemia.
III. Reduction of enterohepatic circulation by drug
therapy
47.
48. PHOTOTHERAPY
*It is non invasive , inexpensive and easy
method of degradation of unconjugated
bilirubin by photo-oxidation. The light
waves converted the toxic bilirubin into
water soluble non –toxic from which is
easily excreted from the blood in the bile
, stool and urine .Phototherapy also
enhances hepatic excretion of
unconjugated bilirubin into the intestinal
lumen.
49.
50.
51. Double surface phototerapy
can be far more effective
management,when the
infant is placed on a optic
fibre cool biliblanket.
Maximum spectral
irradiance or flux is 4 to 6
UW/cm square/nm to be
maintained on infant skin
and should be checked
every 100-200hours.
It should be discontinued
when serum bilirubin is less
than 10mg/dl for 2 times .
52. DRUG THERAPY IN NEONATAL
JAUNDICE
The drugs have very little role in the treatment
of neonatal jaundice.They act by interfering
with heme-degradation , acceleration method
pathway of bilirubin clearance and by
inhibiting enterohepatic circulations.
The drug which can be used to bind
unconjugated bilirubin in the gut and prevent
its recirculation are charcoal , agar , polyvinyl
pyrrolidone and cholestyramine.
53. EXCHANGE BLOOD TRANSFUSION
EBT is most effective and reliable method for
reduction of bilirubin level in case of severe
hyperbilirubinemia to prevent kernicterus and to
correct anemia.
Combining phenobarbitone with phototherapy is
no more effective than phototherapy alone and
hence not used in routine clininals practices.
54.
55.
56.
57.
58.
59.
60.
61. 1. Fluid volume deficit r / t
inadequate fluid intake,
phototherapy, and diarrhea.
INTERVENTIONS
Record the number and quality of
stool
Monitor skin turgor
Monitor intake output
Give breastfeeding or bottle-feed.
62. 2 . Increased body temperature
r / t effects of phototherapy .
INTERVENTIONS
Give a neutral ambient
temperature
Keep the temperature between
35.5 - 37 ° C
Check vital signs every 2 hours.
63. 3 . Impaired skin integrity r / t
hyperbilirubinemia and diarrhoea .
INTERVENTIONS
Assess skin color every 2 hours
Monitor direct and indirect
bilirubin
Change positions every 2 hours
Massage prominent area
Keep your skin clean and moisture.
64. 4 . Impaired parenting r / t separation
INTERVENTIONS
Bring the baby to the mother for
breastfeeding
Encourage parents to talk to their
children
Involve parents in care when possible
Encourage parents to express feelings.
65. 5 . Risk for injury r / t effects of
phototherapy
INTERVENTIONS
Place the neonate at a distance of 45 cm
from the light source
Let the baby naked except for the eyes
Genital area and buttocks covered with
a fabric that reflects light
Assess the presence of conjunctivitis
every 8 hours
66. 6 . Anxiety : parents r / t therapy given
to Infants .
INTERVENTIONS
Assess the client's knowledge of family
Explain the process of therapy and
treatment
Give health education on how to care
of the baby at home.
67. Administration of anti-D immunoglobulin to
the Rh-negative mother having Rh-positive
baby to prevent Rh-isoimmunization.
Minimizing fetomaternal bleeding during
pregnancy
Prevention of perinatal distress – like
hypoxia, hypothermia, hypoglycemia
PREVENTION
68. Adequate and early feed to prevent
dehydration and hypoglycemia to reduce
enterohepatic recirculation
Avoidance of jaundice aggravating drugs like
vitamin K in large doses
Aspiration of cephalohematoma, if presents
with jaundice
Management of Rh-sensitized mother during
antenatal period with rising titer of indirect
Coomb’s test
70. Long term problems
like sexual
maturation ,retinal
damage and rarely
skin cancer
• Bronze baby
syndrome :It is dark
brown pigmentation
of the skin ,mucous
membrane and urine
following
phototherapy
