Neonatal jaundice symptoms and causes and prevention.pptx

Neonatal Jaundice

1. Introduction Jaundice is the yellow colouring of skin and sclera caused by the accumulation of bilirubin in the skin and mucous membranes. Neonatal jaundice occurs in 60% of term infants and 80% of preterm infants [1] and is caused by hyperbilirubinaemia that is unconjugated (divided into physiological or pathological) or conjugated (always pathological). High levels of unconjugated bilirubin have acute harmful e ects as well as long term damage if left untreated, such as kernicterus. 10% of breast fed babies are jaundiced at 1 month

2. Types of Jaundice Physiological jaundice Jaundice in a healthy baby, born at term, is normal and may result from: Increased red blood cell breakdown: in utero the fetus has a high concentration of Hb (to maximise oxygen exchange and delivery to the fetus) that breaks down releasing bilirubin as high Hb is no longer needed Immature liver not able to process high bilirubin concentrations Starts at day 2-3, peaks day 5 and usually resolved by day 10. The baby remains well and does not require any intervention beyond routine neonatal care. Physiological jaundice can progress to pathological jaundice if the baby is premature or there is increased red cell breakdown e.g. Extensive bruising or cephalohaematoma following instrumental delivery. Pathological jaundice Jaundice which requires treatment or further investigation. Haemolytic disease e.g. haemolytic disease of the newborn (rhesus), ABO incompatibility, G6PD deficiency, spherocytosis Onset less than 24 hours ?previous siblings treated for jaundice/family history/maternal rhesus status Maternal blood group (type O most likely to produce enough IgG antibodies to cause haemolysis ) Requires investigation and treatment Bilirubin above phototherapy threshold Onset after 24 hours likely dehydrated ?breast fed baby establishing feeding increased haemolysis due to bruising/ cephalohaematoma Unwell neonate: jaundice as a sign of congenital or post-natal infection Prolonged Jaundice: Jaundice for >14 days in term infants and 21 days in preterm, consider; Infection Metabolic: Hypothyroid/ pituitarism , galactosaemia Breast milk jaundice: well baby, resolves between 1.5-4 months GI: biliary atresia, choledhocal cyst

3. Risk factors and history Risk factors for pathological hyperbilirubinaemia : to be asked in history Prematurity, low birth weight, small for dates Previous sibling required phototherapy Exclusively breast fed Jaundice < 24 hours Infant of diabetic mother