Neonatal Hyperbilirubinemia in gyna .ppt

Neonatal hyperbilirubinemia
In GYNA

1. Neonatal
hyperbilirubinemia
Safwat M. Abdel-Aziz
Assistant professor of pediatrics
Assiut university

2. Neonatal hyperbilirubinemiaNeonatal hyperbilirubinemia
Neonatal hyperbilirubinemia is an elevated
serum bilirubin level in the neonate. There
are two major classifications of
hyperbilirubinemia. Unconjugated
hyperbilirubinemia and conjugated
hyperbilirubinemia.

3. Definition of Neonatal
Hyperbilirubinemia
Jaundice is a yellowish discoloration of skin,
conjunctiva and mucous membranes.
The normal total serum bilirubin (TSB) = 0.1-0.8 mg%.
In adults clinical jaundice is seen if the TSB > 2 mg/dl.
In neonates clinical jaundice is seen if the TSB > 7 mg/dl.

4. Incidence of Neonatal
Hyperbilirubinemia
It occurs in:
25-60% of all full term neonates.
80% of preterm neonates.
6.1% have levels > 12.9 mg/dl.
3% have levels > 15 mg/dl.

5. Source of bilirubin.
1-heme-containing proteins in the RES.
The major heme-containing protein is (RBC) hemoglobin is the
source of 75% of all bilirubin
One gram of hemoglobin produces 34 mg of bilirubin
2-The other 25% from hemoglobin released by ineffective
erythropoiesis & other hem-containing tissue proteins (e.g.,
myoglobin, cytochrome)
newborn 6 to 10 mg of bilirubin/kg/day
in the adult 3 to 4 mg/kg/day

6. Pathophysiology and Etiology of
Neonatal Jaundice
1. Increased bilirubin production
a-Can occur in both physiologic jaundice and
pathologic jaundice
b-Can be caused by hemolytic diseases
c-Can be caused by extravasated blood
(cephalohematoma, extensive bruises)
d-Polycythemia

7. Pathophysiology and Etiology of Neonatal Jaundice (cont)
2. Defective Transport of Bilirubin in the Circulation
3. Defective Bilirubin Uptake by the Liver
4. Defective Conjugation of Bilirubin
5.Impaired Hepatocellular Transport or Excretion of Conjugated Bilirubin
6.Increased Enterohepatic Circulation
7. Obstruction to Bile Flow
8. Hepatocellular Insult

8. Physiological Jaundice
It fulfills the following criteria:
 Full term neonates (FT)
 Appears at Day 2-3

Disappears at Day 6-8 ( 14 )

TSB < 12 mg / dl
 Preterm neonates (PT)
 Appears at Day 3-4

Disappears at Day 10-20

TSB < 12 mg / dl
Diagnostic Criteria of Unconjugated
Hyperbilirubinemia

9. Physiological Jaundice
It fulfills the following criteria:
 Full term neonates (FT)
 Appears at Day 2-3

Disappears at Day 6-8 ( 14 )

TSB < 12 mg / dl
 Preterm neonates (PT)
 Appears at Day 3-4

Disappears at Day 10-20

TSB < 12 mg / dl
Diagnostic Criteria of Unconjugated
Hyperbilirubinemia

10. Late onset by the 4
th
day.
Level may reach 20 to 30 mg/dl by the 14
th
day.
May lead to kernicterus.
These infants show good weight gain, normal LFT and
no evidence of hemolysis .
Mechanism is unknown but theories.
Treatment : stoppage of breast nursing for 2 days will
lower the bilirubin level rapidly and then raise again but
usually not reach the previous level.
Breast Milk Jaundice

11. Decrease intake of milk ( amount and
frequency ) in the first few days, that leads to
increase the enterohepatic circulation.
Breast feeding jaundice

12. Criteria for Pathological
Hyperbilirubinemia
Pathological hyperbilirubinemia should be suspected
when any of the criteria for physiological jaundice are
not fulfilled
Criteria

Clinical jaundice < 36 hours PN

Increase of TSB > 0.2 mg /dl / hr

TSB > 15 mg FT in formula fed
or > 17 mg FT in breast fed

Clinical jaundice > 8 days in full term neonates
> 14 days in preterm neonates

13. Management of Unconjugated
Hyperbilirubinemia
Golden Rule
In any healthy neonate presenting with jaundice, check
serum bilirubin level by laboratory investigations or
jaundice meter.
In a small, sick preterm neonate, even a low range
TSB level may cause kernicterus.

14. Management of Physiological
Jaundice
Reassurance of parents.
Encourage frequent nursing (at least every 3
hours).
Send home with no treatment for a follow-up
after 2 days to reassess TSB.
Ensure adequate hydration of the neonate;
check urination and stooling.

15. Management of Pathological
Unconjugated Hyperbilirubinemia
 Phototherapy
 Exchange transfusion
 Exchange transfusion and phototherapy
PLUS
General measures including:
Increase volume and caloric content of feed and encourage
breastfeeding.
Stop drugs interfering with bilirubin metabolism
Correct hypoxia, infection, acidosis, etc

16. Complications of Unconjugated
Hyperbilirubinemia - Kernicterus
Kernicterus is a state of encephalopathy resulting from the
passage of the fat-soluble unconjugated bilirubin through
the blood brain barrier (BBB) and deposited in the
basal ganglia, putamen and hypothalamus. Cell injury,
neuronal loss and glial replacement can occur with
subsequent neurological damage.

17. Thank you