Neonatal jaundice

1. Neonatal Jaundice
Dr. Abhijeet Deshmukh
DNB Pediatrics
PIMS & RC, Tiruvalla

2. Neonatal Jaundice
•Learning Objectives:
•Define hyperbilirubinemia.
•Differentiate between physiological and
pathological jaundice.
•Causes of hyperbilirubinemia.
•Discuss the pathophysiology of hyperbilirubinemia.
•Describe the most dangerous complication of
hyperbilirubinemia.
•therapeutic management.
•Design plan of care for baby has hyperbilirubinemia.

3. 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.

4. NJ -4

5. 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
•6-10% require phototherapy/ other
therapeutic options.

6. Bilirubin metabolism
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
βglucuronidase

7. NJ -7
Bilirubin Production & Metabolism

8. Clinical assessment of jaundice
(Kramer’s staging)
Area of body Bilirubinlevels
mg/dl(*17=umol)
Face Zone-1: 4-6
Upper trunk Zone-2: 6-8
Lower trunk & thighs 8-16
Arms and lower legs Zone-3: 8-12
Palms & soles Zone-4 :12-14
Zone-5 :>15

9. Physiological jaundice
Characteristics
•Appears after 24-72 hours
•Maximum intensity by 3th-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.

10. Why does physiological jaundice
develop?
•Increased bilirubin load.
•Defective uptake from plasma.
•Defective conjugation.
•Decreased excretion.
•Increased entero-hepatic circulation.

11. 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

12. Causes of jaundice
Appearing within 24 hours of age
•Hemolytic disease of NB : Rh, ABO
•Infections: TORCH, malaria, bacterial
•G6PD deficiency

13. Causes of jaundice
Appearing between 24-72 hours of life
•Physiological
•Sepsis
•Polycythemia
•Intraventricular hemorrhage
•Increased entero-hepatic circulation

14. Causes of jaundice
After 72 hours of age
•Sepsis
•Cephalhaematoma
•Neonatal hepatitis
•Extra-hepatic biliaryatresia
•Breast milk jaundice
•Metabolic disorders (G6PD).

15. Breast feeding jaundice
•In exclusively breast feed infants
•Appears at 24-48 hrs of age
•Peaks by 5-15 days
•Disappears by 3
rd
week
•Its related to inadequate B.F
•T/t:Proper & adequate B.F

16. Breast milk jaundice
•In 2-4 % EBF babies
•SBr>10mg/dl beyond 3
rd
-4
th
week
•Should be differentiated from Hemolytic
jaundice, hypothyroidism, G6PD def
•T/t: Some babies may require PT
Continue breast feeding
Usually declines over a period of time

17. 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

18. Diagnostic evaluation:
•Normal values of unconjugated B. are 0.2 to
1.4 mg/dL.
•Investigate the cause of jaundice.

19. Therapeutic Management
•Purposes: reduce level of serum bilirubinand
prevent bilirubintoxicity
•Prevention of hyperbilirubinemia: early feeds,
adequate hydration
•Reduction of bilirubinlevels: phototherapy,
exchange transfusion,
•Drugs Use of Phenobarbital promote liver
enzymes and protein synthesis.

20. Babies under phototherapy
Baby under conventional
phototherapy
Baby under triple unit intense
phototherapy

21. Prognosis
•Early recognition and treatment of
hyperbilirubinemiaprevents severe brain
damage.

22. 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
Blanching the tip
of the nose

23. 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

24. The goals of planning
•Infant will receive appropriate therapy if
needed to reduce serum bilirubin levels.
oInfant will experience no complications from
therapy.
oFamily will receive emotional support.

25. Thank You!