Neonatal Jaundice Definition, History, investigations and management

Neonatal Jaundice

1. Neonatal Jaundice Understanding the Causes, Diagnosis, and Treatment Paediatrics SHO

2. What is Neonatal Jaundice? Definition: A common condition in newborns characterized by yellowish discoloration of the skin and eyes due to high bilirubin levels. Incidence: Affects 60% of full-term and 80% of preterm infants.

3. Bilirubin Metabolism Bilirubin Production Breakdown of red blood cells (RBCs). Conversion of heme to unconjugated bilirubin. Bilirubin Elimination Liver conjugation of bilirubin. Excretion via bile into the intestines.

4. Types of Neonatal Jaundice Physiological Jaundice Most common, appears after 24 hours of birth, peaks around day 3-5. Pathological Jaundice Appears within 24 hours, often due to underlying conditions like haemolysis or infection. Breastfeeding Jaundice Occurs due to inadequate breastfeeding, leading to dehydration. Breast Milk Jaundice Appears after the first week, related to substances in breast milk that increase bilirubin.

5. Causes of Neonatal Jaundice Increased Bilirubin Production Hemolytic diseases, such as ABO or Rh incompatibility. Decreased Bilirubin Conjugation Immaturity of the liver in premature infants. Increased Enterohepatic Circulation Delayed bowel movement or bowel obstruction.

6. Risk Factors Prematurity Blood Group Incompatibility Bruising During Delivery Sibling History of Jaundice Exclusive Breastfeeding (with insufficient intake)

7. Symptoms and Signs Yellowing of Skin and Eyes Typically starts on the face and spreads downward. Lethargy Poor Feeding High-Pitched Cry Dark Urine

8. Diagnosis Physical Examination : Visual assessment of jaundice progression. Laboratory Tests Serum Bilirubin Levels: Total and direct bilirubin. Blood Type and Coombs Test: To check for incompatibility. Full Blood Count (FBC): To assess for hemolysis.

9. Management and Treatment Phototherapy Blue light converts unconjugated bilirubin to a water-soluble form. Exchange Transfusion Used in severe cases to remove bilirubin and antibodies. Hydration and Feeding Support Ensuring adequate feeding to promote bilirubin excretion.

10. Complications of Untreated Jaundice Kernicterus Bilirubin-induced brain dysfunction. Neurological Damage Can result in hearing loss, cerebral palsy, or intellectual disabilities.

11. Prevention Early Feeding Frequent breastfeeding to enhance bilirubin excretion. Monitoring Regular bilirubin checks for at-risk infants. Education Informing parents about signs of jaundice and when to seek help.

12. Key Takeaway messages Neonatal jaundice is common but usually benign. Early detection and treatment are crucial to prevent complications. Phototherapy is the primary treatment for most cases.

13. Questions