This document discusses pathological jaundice and kernicterus in newborns. Kernicterus is a neurological syndrome caused by deposition of indirect bilirubin in the brain, with symptoms varying depending on if it is the acute or chronic form. Prevention focuses on frequent monitoring of bilirubin levels and early phototherapy treatment if elevated. Diagnosis involves history, exam, and lab tests. Treatment options are phototherapy or exchange transfusion if phototherapy fails or risks of kernicterus are high. Complications of each treatment are also outlined.

1. Etiologies of pathological jaundice
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4. Kernicterus ( bilirubin encephalopathy)
• Definition: neurological syndrome resulting
from deposition of indirect bilirubin in the
basal ganglia and brain stem
• Multifactorial→ the precise blood level and
the duration of exposure is not known
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5. Clinical features of kernicterus
Acute form
• Phase 1 ( 1st-2nd d): poor sucking, stuper,
hypotonia, seizure
• Phase 2(middle of 1st wk): hypertonia of
extensor muscles, opisthonos, retrocollis,fever
• Phase 3(after 1 wk):hypertonia
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6. Chronic form
• 1st year: hypotonia, active deep tendon
reflexes, obligatory tonic neck reflex, delayed
motor skill
• After 1st year:movement
disorder(choreoathetosis,ballismus, tremor),
upward gaize, sensorineural hearing loss
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7. Prevention of kernicterus
1. for any neonate with jaundice within 24hrs, serum
bilirubin level should be checked
2. Follow up within 2-3d of discharge for all neonate
discharged earlier than 48hr
3. Recognize the presence of possible risk factor
4. Never underestimate the severity of jaundice by
visual assessment
5. Early initiation of phototherapy in those with elevated
bilirubin
6. Recognize parental concern regarding jaundice, poor
feeding, lethargy
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8. Diagnosis of pathological jaundice
History and physical examination
• Time of onset, duration, color, and pattern of jaundice
• Symptoms suggestive of anemia,polycythemia
• Family history
• Maternal blood group and rh
• Perinatal hx (sns&sms of infection, drug)
• Term/premature?
• Me conium passed /not?
• Breast feeding/not?
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9. • Hematoma/ bruising
• Nutritional status
• Respiratory destress/not
• Hepato-spleenomegally
• Sns &sms suggestive of sepsis
• Vomiting, lethargy, poor feeding, apnea,
bradycardia, excessive weight loss
• Light colored stool, dark urine
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10. Laboratory investigation
• TSB and direct bilirubin level
• Blood type(ABO, Rh)
• Direct antibody test(coombs test)
• Serum albumin
• CBC with differential and smear for RBC
morphology
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11. • Reticulocyte count
• ETCO(end tidal carbon monoxide)
• G6PD( Glucose-6-phosphate dehydrogenase)
• Urine for reducing agents
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12. Treatment of hyperbilirubinemia
Goal: to prevent neurotoxicity while not
causing harm.
• phototherapy
•Exchange transfusion
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13. Phototherapy
• Exposure to high intensity of light in the visible
spectrum
• Maximally in the blue range(420-470nm)
• Broad spectrum(white, blue) and narrow-
spectrum(super blue)
• Photochemical reaction
reversible photo-isomerization
lumirubin-irreversible structural isomer
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14. • Factors
light enery emitted in the effective range
distance b/n neonate and the lights
surface area of the exposed skin
the rate of production, metabolism and
excretion
• Imtensive phototherapy
special blue fluorescent tubes
lamp 15-20
fiber optic phototherapy blanket
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15. • Not substitute for exchange
transfusion(indicated)
• Monitoring: continuous, turned frequently, serum
bilirubin and hematocrit every 4-8 hr should
continue for at least 24 hr after Rx, skin color is
not reliable.
• Role of iv fluid supplementation- dehydrated pts ,
level neat to exchange
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17. Complications of phototherapy
• Loose stool, erythematous macular rash,
purpuric rash—transient porphyrinemia
• Overheating, dehydration, hypothermia,
bronze baby syndrome ( dark, grayish-brown
skin discoloration), corneal damage
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18. Exchange transfusion
• Indications
if intensive phototherapy fails
if the risk of kernicterus exceeds the risk of pr
if signs of kernicterus are evident
if the TSB is in the range for exchange
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20. • the total amount of blood exchanged is equal to
2x the neonates blood volume
Weight(kg) x 85 ml/Kg x 2
• 5-20ml/cycle are withdrawn and infused, 45-90
min
• Should remove 85% of infant’s RBC, maternal
antibodies, and exchangeable tissue ind.bilirubin
• Catheter
• Continuation of photherapy-reduces subsequent
exchange transfusion.
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21. complications
• Blood( transfusion rxn, metabolic instability,
infection), catheter(vessel perforation),
procedure( hypotension or necrotizing
enterocolitis)
• Late-anemia
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