Pathogenesis of Neonatal Jaundice.pptx

Pathogenesis of Neonatal Jaundice

1. Pathogenesis of Neonatal Jaundice

2. OBJECTIVE OF SEMINAR At the end of the session the student will be able To: Define Neonatal jaundice and ROP State Risk factors , Etiology,Types and Diagnostic Evaluation of Neonatal jaundice and ROP . Apply the management of Neonatal jaundice and ROP at their clinical set-up .

3. INTRODUCTION Definition: Hyperbilirubinemia refers to an excessive level of bilirubin in the blood and is characterized by a yellowish discoloration of the skin, sclerae, mucous membranes and nails. Bilirubin is the end product of heme degradation Heme biliverdin bilirubin Bilirubin is released and bound to serum albumin

4. Hb → globin + haem 1g Hb = 34mg bilirubin Represent about 75% Non – heme source 25% of bilirubin Bilirubin

5. BILIRUBIN METABOLISM

6. Normally s. bilirubin level vary between 0.3 - 1.2mg/dl . A bilirubin level of more than 2 mg/dl manifest biochemically where as level of >5 mg/dL manifests clinically in neonates UNCONJUGATED B. Insoluble in water can not be excreted in urine Tightly compounded to s. albumin Toxic CONJUGATED B. Water soluble& can be excreted in urine Loosely bound to albumin. Non toxic

7. RISK FACTORS FOR DEVELOPMENT OF SEVERE HYPER BILIRUBINEMIA IN INFANTS ≥35 WEEKS OF GESTATION MAJOR RISK FACTORS Pre discharge TSB or TCB level in the high-risk zone Jaundice observed in the first 24 hours Blood group incompatibility with positive direct coombs test , other known hemolytic disease (glucose-6-phosphate dehydrogenase deficiency). Gestational age 35-36 weeks Previous sibling received phototherapy

8. Cephalo-hematoma or significant bruising Exclusive breast-feeding, particularly if nursing is not going well and weight loss is excessive East Asian race*

9. MINOR RISK FACTORS Pre discharge TSB or TCB level in the high intermediate risk zone Gestational age 37-38 week Jaundice observed before discharge Previous sibling with jaundice Macrosomic infant of a diabetic mother Male gender

10. DECREASED RISK (these factors are associated with decreased risk of significant jaundice) TSB or TCB level in the low-risk zone Gestational age ≥ 41 weeks Exclusive bottle-feeding Black race Discharge from hospital after 72 hour