Pathological neonatal jaundice11/22/2023 ![]() ![]() Hyperbilirubinemia is a common disease that occurs especially in the first week of birth and is one of the most common causes of hospitalisation of the term and preterm infants in neonatal hospitals. Based on the present evidence, 80% of premature infants have clinical symptoms, including yellowish skin and sclera, caused by serum bilirubin levels. Two times the baby’s blood volume is exchanged, either through a UVC (umbilical venous catheter) or a peripheral vein paired with an arterial line.Neonatal jaundice is a common event that occurs especially in the first week of birth and is one of the most common causes of hospitalisation of the term and preterm neonates in neonatal wards. Exchange transfusions are when the baby’s blood is replaced with carefully matched and screened donated blood.More recently special fibre optic blankets have been developed which can be used. Some babies also develop a rash as a result of the phototherapy. Some mothers find this very frustrating as it reduces bonding time with the baby however feeding must continue, which gives them some time together. The baby needs to be completely naked, apart from eye protection, and needs to be under the lights as much as possible, until bilirubin levels come down. At this wavelength light converts non-conjugated bilirubin into a harmless substance and decreases bilirubin levels. This is when the baby is subjected to blue light of a specific wavelength (450nm). If above the phototherapy line then start phototherapy.Make sure the baby is well hydrated and nourished, and repeat bilirubin levels. If under the phototherapy line, and other investigations have come back as negative, then treatment is supportive.Use a bilirubin chart! Measures bilirubin against age.The management of conjugated bilirubinaemia is more complex and dependent on the underlying cause. Management of unconjugated huperbilirubinaemia is outlined below. Involve paediatric gastroenterologist early to discuss the management options Total serum bilirubin (SBR) levels depend on gestation age.If prolonged or the clinical picture is suggestive, then biliary US or other radiology.Urine dipstick and culture, to look for bilirubin, and a source of sepsis.As with everything, a thorough history and examination.It is important to reassure the mother that this is a common occurrence she should continue breastfeeding even though the jaundice may still be there. It has long been known that breastfed babies are often more jaundiced, and for longer than bottle fed babies. Breastfeeding Jaundice is thought to result from increased enterohepatic bilirubin.The newborn liver cannot cope with all of this bilirubin, and so it builds up in the blood.Foetal haemoglobin has a shorter life span than adult haemoglobin and is constantly being broken down at a high rate.It is caused by a combination of the following two factors: Physiological Jaundice is very common, usually appearing around day 2-4, peaking at 7 days and then regressing.Although other causes must be excluded, the most common causes in this time period are This is a tricky period, as this is the timeframe physiological or breastfeeding jaundice often manifests, however it is also the time more serious conditions also present with jaundice. ![]() ![]() However can be caused by infection either from the mothers genital tract or in the amniotic fluid, therefore a TORCH screen should be used.The commonest cause is due to haemolysis usually due to either ABO incompatibility, Rhesus disease of the newborn or Hereditary Spherocytosis.Conjugated causes often have a more serious underlying cause, and the management depends on treating the underlying cause.In severe cases, or other causes, they can often be treated by phototherapy, or if required in serious cases, exchange transfusion In the case of physiological and breast milk jaundices, often no treatment is required. Jaundice with onset BEFORE 48 hours, or AFTER 3 days is more likely to be pathologicalĪs well as dividing cases by the time and duration of onset, they can be divided into unconjugated and conjugated. Prolonged Jaundice occurring after 14 days.Jaundice within the first 24 hours of life.Neonatal Jaundice can be split into three time periods ![]()
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