Neonatal Jaundice

Jaundice

* Definition
* Incidence
* Lab Dx
* Physical Exam

• Jaundice is a yellow discoloration of the skin, sclera and mucus membranes

• Approximately 75% of all newborns become clinically jaundiced in the first week of life

• Jaundice is clinically visible when the total serum bilirubin exceeds 85umol/L

• However, the physical examination is NOT a reliable method of estimating the serum bilirubin level and either a non-invasive transcutaneous bilirubin or a formal total serum bilirubin must be done to determine the bilirubin level

Bilirubin synthesis, transport and metabolism

Categorisation of hyperbilirubinaemia

* Unconjugated
* Conjugated

Causes of unconjugated jaundice: Increased Production

* Intra-vascular:

Physiological:

• Increased RBC breakdown

• High haemoglobin no longer required

• Shorter lifespan of RBC

\
Pathological:

Allo-immune hemolysis:

• ABO incompatibility

• Rh Incompatibility

• Minor antigen incompatibilities

\
Non-immune hemolysis:

• RBC membrane defects

• RBC haemoglobin defects

• RBC enzyme defects

\
* Extra-vascular blood:

• Cephalhematoma

• Bruising

• Subaponourotic bleed

• Intraventricular bleed

Causes of conjugated jaundice

Hemolysis

* Allo-immune
* Non-immune

Blood Groups

ABO Incompatibility

Maternal blood group O

Newborn blood groups A & B

\
Maternal preexisting IgG antibodies can cross the placenta

RH incompatibility

Immune Haemolysis

Non-immune haemolysis

Investigations for making the diagnosis of intravascular haemolysis

• Haemoglobin (decreasing / low)

• Reticulocytes (high)

• LDH (high)

• Haptoglobin (low)

• RBC fragments (smear)

Causes of unconjugated jaundice: decreased uptake and conjugation

Causes of unconjugated jaundice: increased enterohepatic circulation

Steps to follow for the investigation of neonatal jaundice

The classification of jaundice

Physiological \*

Pathological \*

Management: unconjugated jaundice

Phototheraphy

Intravenous Immunoglobulin (IVIG)

Exchange Transfusion

Dangers of unconjugated jaundice

Phototheraphy

\-Indications

\-Contraindications

How does phototheraphy work

Phototheraphy

* Technique
* Complications
* Types

Phototheraphy chart

Exchange Transfusion Chart

Exchange Transfusion

* Mechanism
* Blood for exchange
* Technique

Exchange transfusion complications

Intravenous Immunoglobulin IVIG

IVIG Study

SUMMARY