Transcript Jaundice in the newborn

‫بسم هللا الرحمن الرحيم‬
Jaundice in the newborn
DR Husain Alsaggaf
Jaundice in the newborn
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Clinical jaundice
appear at SB 5 mg/dl
25% to 50% of term
newborns have clinical
jaundice.
Jaundice may caused
by serious illness or
lead to keriniectrus.
75% of bilirubin comes
from haemoglobin and
25% from other sources
Neonatal jaundice
Neonatal jaundice
physiological
pathological
conjugated
unconjugated
Intrahepatic
Hepatic injures
infectious
metabolic
Neonatal hepatitis
Extrahepaitc
Paucity of hepatic
ducts
Physiological jaundice
Start after the first 24hours.
 Peak in the fourth or fifth day {not >12
mg/dl} in term babies and not more than
15 mg/dl in premature
 The baby is well.
 Clear in week in term and two weeks in
premature.
 Bilirubin is unconjucated.
 The rise is not more than 0.5 mg /h
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Causes of physiological jaundice
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High haemoglobin
Decrease RBC life
span.
Increase
enterohepatic
circulation.
Defective conjugation.
Decrease hepatic
excretion
Pathological jaundice
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Unconjucated
High Hg mass
Haemolysis.
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Blood group
incompqatability.(RH.A
BO.)
Red cell membrane
defect (spherocytosis)
Heamoglobinopathy.
Haemolytic agents (vit
k3.oxytocin)
Infection E.coli
Causes of unconjucated
hyperbiliruniemia
Liver cell membrane defect (GILBRET).
 Defective conjugation.
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Jaundice of prematurity.
 Breast milk jaundice.
 Hypothyroidism.
 Hereditary(crigler-najjar).
 Other conditions Pyloric stenosis,infant of
diabetic mother, down's syndrome
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Investigation of unconjhyberbilirubinneamia
Split biliurubin.
 Blood groups and Rh.
 coomb’s test.
 CBC and reticulocyte.
 G-6-P-D estimation
Blood film and osmotic fragility test.
TFT and urine for reducing substance.
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Causes of conjugated
hyberbilirubineamia
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Hepatitis:
CMV.toxoplasmosis.rubella.herpes.giant
cell,Hep A and b,syphilis,E coli.
Metabolic:
Galctosemia,Tyroseanemia,Fructoseamia.
Cystic fibrosis.
Alpha one anti trypsin deficiency.
Gauchers and neimman pick
Biliary Artesia (intrahepatic and extrahepatic)
Choldoccal cyst.
T.P.N
Investigation of conjugated
hyperbiliruniemia
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L.F.T
PT.PTT.
Urine for glucose and
reducing substance.
Serum and urine amino
acid determinations.
TORCH serology.
Ultrasound.
Liver scan
Duodenal aspiration.
Liver biopsy.
Approach To neonatal jaundice
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History.
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FH of aneamia,spleenomegaly.
Jaundice in other sibling
(breast milk jaundice.Rh
disease)
FH of liver disease
(galactoseamia,alpha-oneantitrypsin difficiency,cystic
fibrosis, Gilbert and criglernajjar)
Maternal illness during
pregnancy (TORCH and
diabetes).
Maternal drugs.(sulfanomide
Labour and
delivery(Truma,oxytocin,delaye
d clamping of the
cord,prematurity.
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Infant history.
Feeding (breast milk
jaundice).
Poor feeding.
Vomting(sepsis
pyloric
stenosis,galactosemia
Examination
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Small for date(polycythemia, in-utroinfection.
Premature
Extravagated blood(briuses
,cephaloheamatoma).
Pallor(heamolytic anaemia and extravagated
blood)
Cherioretinitis,cataract,(congenital
infection,galactoseamia)
Petechia rash (congenital
infection,galactoseamia)
Hepatospleenomegaly(heamolytic anaemia
,congenital infection, liver diseases)
Management
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Prevention:
Rh incompatibility----- Anti D
 Syphlis---Pencilline
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Specific therapy:
Septicaemia---- Antibiotic.
 Surgery------------ Ex hepatic biliary Artesia.
 Galctose withdrawal for galactoseamia.
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Management of unconjucated
hyberbilirubineamia
Phototherapy
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Wave length 450-460
-- Reduce bilirubin
To harmless
compound excreted in
the urine.
Complication:
Retinal damage,
nasal obstruction,
mild
diarrhea,dehydration,
bronzed baby
syndrome
Exchange Transfusion
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Indicated when
bilirubin reach toxic
level.
Mortality1%
Remove bilirubin
,antibodies ,correct
anaemia.
Double blood volume
is used 85 ml /kg
COMPLICATION.
Infection,acidosis,Cad
Phenobarbitone
This act as enzyme inducer which
increase amount of glucoreny transferase
and protein z.
 Used in crigler najjar
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Kernicterus
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Yellow staining of
nuclear centres of the
brain
Due to high level of
indirect bilirubin.
Bilirubin cause neural
loss.
Bilrubin inhibit cell
respiration, protein
synthesis,glucouse
metabolism.