1. JAUNDICE IN NEWBORN

2. DEFINITION
YELLOWISH DISCOLORATION OF SKIN AND THE MUCOUS IS
CAUSED BY ACCUMULATION OF EXCESS OF BILIRUBIN IN
THE TISSUE & PLASMA (SERUM BILIRUBIN LEVEL > 7mg% )

4. CAUSES OF NEONATAL JAUNDICE
 Physiological
Usually appears on 2nd and 3rd day and disappears on
7th to 10th day
In term infant level may be 6-8mg/dl
causes:
1)Increased red cell volume and increased red cell
destruction
2)transient decreased conjugation
3)Increased enterohepatic circulation
4)decreased hepatic excretion of bilirubin

5. PATHOLOGICAL
• ABSOLUTE FEATURES:
A) Jaundice appearing within 24 hours of pregnancy
B) Unconjugated bilirubin level > 12.9mg/dl in a term infant
C) Unconjugated bilirubin level >15mg/dl in a preterm infant
D) Bilirubin level increasing at the rate of >5mg/dl/day
E) Conjugated bilirubin > 2mg/dl
F) Clinical jaundice persisting > 1 week in a term infant or
2 weeks in a preterm infant

6. 1)Excessive red cell hemolysis
a)Hemolytic disease of newborn
b)Sepsis
c)Blood extravasation
2)Defective conjugation of bilirubin
a)Congenital deficiency of GT
3)Breast milk jaundice
4)Metabolic and endocrine deficiency
5)Increased enterohepatic circulation
6)Substance and disorder that affect binding of bilirubin to
albumin
7)miscellaneous
CAUSES OF PATHOLOGICAL
JAUNDICE

7. HYPERBILIRUBINEMIA
When the bilirubin level rises more than the arbitrary cut-off point of 10
mg%,in a term infant the condition is called “hyperbilirubinemia of the
newborn”.
Unconjugated: Hemolytic disease due to Rh (common) or ABO (rare)
incompatibility
prematurity
G6PD deficiency
Sepsis
iatrogenic drugs
cephalhematoma, cretinism, etc
Conjugated: Neonatal hepatitis
bacterial infection
TORCH infection
Trisomy 18, 21

8. DIAGNOSIS OF NEONATAL
HYPERBILIRUBINEMIA
A.CLINICAL
Sr. bilirubin >5mg/dl
B.LABORATORY STUDIES
a)Serum bilirubin level >12mg/dl, requires further investigation
1)Total conjugated bilirubin and unconjugated bilirubin
2)complete hemogram including reticulocyte count
3)Blood group (ABO, Rh) status
4)Direct Coombs’ test (infant)
5)Serum albumin
6) Other laboratory tests :
Urine
Hemoglobin electrophoresis
Osmotic fragiltity
Thyroid and liver function tests
G6PD screening
C) Radiology and Ultrasonography
5mg/dl
10mg/dl
12mg/dl
15mg/dl
>15mg/dl

9. KERNICTERUS
Is a pathological condition characterized by yellow staining of the
brain by unconjugated bilirubin resulting in neural injury.
Basal ganglia
Cranial nerve nuclei
Hippocampus
Brain stem nuclei
Ant horn cell of spinal cord
Clinically characterized by lethargy, hypotonia, poor feeding and
loss of neonatal reflexes
Severe illness-prostration, respiratory distress and finally
ohisthotonus, hyperpyrexia, convulsion, enlarged liver and spleen
Rx
double surface phototherapy
exchange transfusion
use of barbiturate

10. MANAGEMENT
1)PHOTOTHERAPY: bilirubin level > 12mg%
420-480nm
DOUBLE PHOTOTHERAPY
bilirubin to lumibilirubin by structural
isomerization
Complications: watery diarrhea, skin
rashes, dehydration, bronze baby syndrome and retinal
damage
2)PHARMACOLOGIC THERAPY:PHENOBARBITONE
10mg/kg on day 1
5-8mg/kg for next 4 days
Prophylaxis: mother for 2 weeks prior to delivery

12. 4)EXCHANGE TRANSFUSION :Double vol exchange
replaces 85% of circulating red blood cells and reduces
bilirubin level; by 50%
Indications;
Rise in bilirubin level >1mg/dl inspite of phototherapy
Rise >0.5mg/dl /hr despite phototherapy when Hb is
between 11-13g/dl
To improve anemia and CCF
The sr. bilirubin is >12mg/dl in first 24 hours and >20
mg/dl in neonatal period
Cord blood hemoglobin is <12g/dl and bilirubin level is
> mg/dl
Progressive anemia
Nonimmune hyperbilirubinemia –two vol exchange is

13. Air Embolism
Thrombosis
Hypervolemia
RDS
Hypothermia
Acidosis
Infection
Hyperkalemia
Hypocalcemia
Hypoglycemia
Cardiac arrhythmias
Thrombocytopenia
Coagulopathy
Necrotising enteritis
Complications:

14. THANKYOU
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