Neonatal Jaundice

NEONATAL JAUNDICE

Clinical jaundice in newborn appears at bilirubin level >5mg/dl

Jaundice during 1st week of life is seen in 60% term infants and 80% preterm.

Causes of Conjugated Hyperbilirubinemia

Non obstructive causes :

Obstructive causes :

Modified Krammer’s Rule

Clinical Features

Kernicterus or bilirubin encephalopathy is a neurologic syndrome resulting from deposition of unconjugated bilirubin.

Lethargy, poor feeding and loss of Moro reflex, tendon reflexes.

Opisthotonus with a bulging fontanel and shrill high pitched cry.

In advanced cases, convulsions, coma and death.

Diagnostic evaluation

  • Determination of direct and indirect bilirubin
  • Hemoglobin with reticulocyte count and peripheral smear
  • Blood grouping and coomb’s test

Treatment

Goal of therapy is to prevent neurotoxicity
  • Phototherapy
  • Exchange transfusion
  • Drugs
  • Phototherapy
  • Most effective wavelength: 450-460nm
  • Mechanisms
  • Photo isomerization
  • Structural isomerization: Bilirubin is converted to lumirubin which is irreversible structural isomer excreted by kidneys
  • Photo oxidation
  • Therapeutic effects of phototherapy depend on
  • Types of lamps: LED lamps are better
  • Distance between light and infant
  • Surface area of exposed skin
  • Complications
  • Loose stools, dehydration due to increased insensible water loss
  • Hypocalcemia
  • Bronze baby syndrome: due to elevated conjugated bilirubin
  • Retinal toxicity
  • Gonadal toxicity
  • Temperature disturbances

Phototherapy is contraindicated in porphyria

  • Exchange transfusion
  • Double volume exchange transfusion is done if high bilirubin levels and intensive phototherapy has failed
  • Drugs
  • Intravenous immunoglobulin

Used as adjunctive in hyperbilirubinemia due to hemolytic disease

Reduces the need for exchange transfusion by reducing hemolysis

Important points to remember

  • Area of brain most commonly involved: Basal ganglia
  • Extrapyramidal type of cerebral palsy seen in neonatal jaundice
  • Most important mechanism of phototherapy: structural isomerization
  • Effectiveness of phototherapy does not depend on pigmentation of body
  • Genitalia and eyes of baby must be covered during phototherapy
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