Neonatal jaundice

Neonatal jaundice

1. Neonatal Jaundice
MR.SACHIN T.GADADE
M.SC(N) PEDIATRICS

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3. Neonatal Jaundice
•Learning Objectives:
• Define hyperbilirubinemia.
•Differentiate between physiological and pathological
jaundice.
•State causes of hyperbilirubinemia.
•Discuss the pathophysiology of hyperbilirubinemia.
•Describe the most dangerous complication of
hyperbilirubinemia.
• List the three elements of therapeutic management.
•Design plan of care for baby has hyperbilirubinemia.
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4. Neonatal Jaundice
(Hyperbilirubinemia)
•Definition: Hyperbilirubinemia refers to an
excessive level of accumulated bilirubin in the
blood and is characterized by jaundice, a yellowish
discoloration of the skin, sclerae, mucous
membranes and nails.
•Unconjugated bilirubin = Indirect bilirubin.
•Conjugated bilirubin = Direct bilirubin.
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6. Neonatal Jaundice
•Visible form of bilirubinemia
•Newborn skin >5 mg / dl
•Occurs in 60% of term and 80% of preterm
neonates
•However, significant jaundice occurs in 6 % of
term babies
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7. Bilirubin metabolism
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Hb → globin + haem
1g Hb = 34mg bilirubin
Non – heme source
1 mg / kg
Bilirubin
glucuronidase
Bilirubin
Bilirubin
Ligandin
(Y - acceptor)
Bil glucuronide
Intestine
Bil
glucuronide
Stercobilin
bacteria
β glucuronidase

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Bilirubin Production & Metabolism

9. Clinical assessment of jaundice
Area of body Bilirubin levels
mg/dl (*17=umol)
Face 4-8
Upper trunk 5-12
Lower trunk & thighs 8-16
Arms and lower legs 11-18
Palms & soles > 15
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11. Physiological jaundice
Characteristics
•Appears after 24 hours
•Maximum intensity by 4th-5th day in term & 7th day in
preterm
•Serum level less than 15 mg / dl
•Clinically not detectable after 14 days
•Disappears without any treatment
Note: Baby should, however, be watched for worsening
jaundice.
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12. Why does physiological
jaundice develop?
•Increased bilirubin load.
•Defective uptake from plasma.
•Defective conjugation.
•Decreased excretion.
•Increased entero-hepatic circulation.
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Age in Days
Term
Preterm
1 2 3 4 5 6 10 11 12 13
14
15
10
5
B
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m
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/
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Course of physiological
jaundice

14. Pathological 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 and urine staining clothes
yellow
•Direct bilirubin> 2 mg / dl
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15. Causes of jaundice
Appearing within 24 hours of age
•Hemolytic disease of NB : Rh, ABO
•Infections: TORCH, malaria, bacterial
•G6PD deficiency

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17. Causes of jaundice
Appearing between 24-72 hours of life
•Physiological
•Sepsis
•Polycythemia
•Intraventricular hemorrhage
•Increased entero-hepatic circulation
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18. Causes of jaundice
After 72 hours of age
•Sepsis
•Cephalhaematoma
•Neonatal hepatitis
•Extra-hepatic biliary atresia
•Breast milk jaundice
•Metabolic disorders (G6PD).
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19. Risk factors for jaundice
JAUNDICE
•J - jaundice within first 24 hrs of life
•A - a sibling who was jaundiced as neonate
•U - unrecognized hemolysis
•N – non-optimal sucking/nursing
•D - deficiency of G6PD
•I - infection
•C – cephalhematoma /bruising
•E - East Asian/North Indian
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20. Diagnostic evaluation:
•Normal values of unconjugated B. are 0.2 to 1.4
mg/dL.
•Investigate the cause of jaundice.
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21. Therapeutic Management
•Purposes: reduce level of serum bilirubin and
prevent bilirubin toxicity
•Prevention of hyperbilirubinemia: early feeds,
adequate hydration
•Reduction of bilirubin levels: phototherapy,
exchange transfusion,
•Drugs Use of Phenobarbital promote liver
enzymes and protein synthesis.
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23. Babies under phototherapy
Baby under conventional
phototherapy
Baby under triple unit intense
phototherapy

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27. Prognosis
•Early recognition and treatment of
hyperbilirubinemia prevents severe brain
damage.
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28. Nursing considerations of
Hyperbilirubinemia
•Assessment:
 observing for evidence of
jaundice at regular intervals.
 Jaundice is common in
the first week of life and
may be missed in dark skinned
babies
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Blanching the tip
of the nose

29. Approach to jaundiced baby
•Ascertain birth weight, gestation and postnatal age
•Ask when jaundice was first noticed
•Assess clinical condition (well or ill)
•Decide whether jaundice is physiological or
pathological
•Look for evidence of kernicterus* in deeply
jaundiced NB
*Lethargy and poor feeding, poor or absent Moro's, or
convulsions
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30. Nursing diagnosis
•See the high risk infant plan of care. Plus:
 Body T., risk for imbalanced T. related to use of
phototherapy.
 Fluid volume, risk for deficient related to
phototherapy.
 Interrupted family process related to situational
crisis, re hospitalization for the therapy.
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31. The goals of planning
•Infant will receive appropriate therapy if needed
to reduce serum bilirubin levels.
o Infant will experience no complications from
therapy.
o Family will receive emotional support.
o Family will be prepared for home phototherapy
(if prescribed).
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