Neonatal Jaundice CPGNeonatology Department

Hadi Clinic

Neonatal Jaundice : Condition marked by

high levels of bilirubin in the blood

Yellowish discoloration of skin & mucous membrane

Bilirubin level >5mg/dl (85 µmol/L)

‘Cephalo – Caudal distribution’

Normal term neonates : 30% - 50%

Introduction

1. Physiological Jaundice

Appears within 2 – 3 days (>24hrs of age)

Most common due to immaturity of bilirubin UDGT

activity

2. Pathologigal Jaundice

Appears within 24hrs

Common cause : ABO , Rh incompatibility & Sepsis

Classification

1. Unconjugated – Lipid Soluble

Hemolytic Disease : ABO, Rh incompatibility

G-6-PD deficiency

Breast Milk Jaundice

High level results in Kernicterus

2. Conjugated – Water Soluble

Conjugated bilirubin >= 20% total bilirubin

DR Alfa ABC GoT Conjugated Hyperbilirubinemia due to

sepsis

Causes of Pathological Jaundice

Blood Group O

Rh –ve mother

Previous sibling developed significant

hyperbilirubinemia

Infant of diabetic mother (IDM)

Preterm infants

Risk Factors

For all jaundiced babies : CBC , ABO , RH , TSB , Direct

Bilirubin level

Infants with elevation of direct-reacting bilirubin : Urinalysis

& Urine Culture for sepsis.

Additional evaluation for Sepsis : CBC, CRP, Blood C/S

Jaundiced baby at or beyond 3 weeks : measurement of

total and direct or conjugated bilirubin to identify

cholestasis

Laboratory Investigation

Phototharapy => Configurational Isomerization

Intensive Phototherapy recommended for higher risk

Bilirubin absorbs light best at 430 - 490 nm, but longer

wavelength penetrate skin better.

Skin is exposed as possible & that light is not too far from baby.

Exchange Transfusion => TSB rises despite of intensive

phototherapy.

IVIG => competitive inhibitor of antibodies that cause

haemolysis

Treatment

American Academy of Pediatrics,

Sub committee on Hyperbilirubinemia

Maisels MJ, Watchko JF, Treatment of

Jaundice in low birth weight infants.

Ip S , Chung M Kulig J et al. An evidence

based review of important issues concerning neonatal

hyperbilirubinemia. Pediatrics 20011,113(6)

References

Thank You!