Neonatal Jaundice
Neonatal Ward
Dr,Ziyu Hua
Classification of neonatal jaundice
Physiological jaundice
Pathological jaundice
Etiology of physiological jaundice
In the first few days after birth,haemoglobulin
concentration falls rapidly.
Red cell life span of newborn infants is 70 days
which is much shorter than that of adults(120 days).
Hepatic bilirubin metabolism is less efficiency.
Jaundice is important as
A sign of another disorder,e.g,infection,hemolysis
Kernicterus,a severe complication of neonatal jaundice,
indirect bilirubin (UB) deposited in the brain (basal
ganglia),
Warning
There are no bilirubin levels which are
known to be safe or which will definitely
cause kernicterus,
Infants who experience severe hypoxia,
hypothermia or any serious illness may
be susceptible to damage from
hyperbilirubinemia.
Severity of jaundice
The jaundice starts on the head and face,
spreads down the trunk and limbs.
How to measure:
Observation by eye,blanching the skin
Transcutaneous jaundice meter
Blood sample,minibilirubin meter
Gestation
Preterm infants may be damaged by a lower
bilirubin level than term infants.
Age from birth is important,higher tolerance
with increasing age.
Rate of change
Rate of rise tends to be linear until reaching plateau.
Rapid rise with increasing harm.
Serial measurement of serum bilirubin,suitable
intervention when necessary.
Etiology of pathological jaundice
Age of onset is a useful guide to likely
cause of jaundice.
Within 24 hrs
During 24 hrs to 2 wks
After 2 wks
Jaundice within 24 hrs of age
Hemolytic disorders,UB,rise rapidly,high level
Rhesus hemolytic disease,jaundice,anemia,hydrops,
hepatosplenomegaly; antenatal identify,fetal therapy.
ABO incompatibility,less severe,more common,slight
or without anemia,peak in the first 12— 72hrs.
G6PD deficiency,epidemiology; some drugs,infection,
hypoxia.
Jaundice within 24 hrs of age
Hemolytic disorders
Spherocytosis,less common,family history;
spherocytes found on the blood film,
Congenital infection,conjugated bilirubin,
other abnormal clinical signs.
Jaundice at 24 hrs to 2 wks of age
Physiological jaundice
Infection,unconjugated hyperbilirubinemia; abnormal
metabolism of bilirubin; pneumonia,sepsis,hepatitis,
urinary tract infection.
Other causes,bruising,polycythaemia (venous hematocrit
>65%); Crigler-Najjar syndrome (inherited deficiency of
enzyme glucuronyl transferase)
Jaundice at 24 hrs to 2 wks of age
Breast milk jaundice,prolonged,unconjugated
hyperbilirubinemia; unknown cause; declined bilirubin
with interruption of breast-feeding; may be harmless,
It is unnecessary to stop breast-feeding when
breast milk jaundice is diagnosed.
Jaundice at >2 wks of age(persistent)
Unconjugated hyperbilirubinemia:
Infection,particularly of urinary tract.
Congenital hypothyroidism,neonatal biochemical
screening; clinical manifestations (constipation,dry skin,
coarse facies,hypotonia)
Breast milk jaundice,most common,15% affected;
disappears by 3-4 wks of age.
Jaundice at >2 wks of age(persistent)
Conjugated hyperbilirubinemia:
Neonatal hepatitis syndrome(TORCH),biliary atresia;
Dark urine and unpigmented pale stools;
Biliary atresia should be diagnosed as soon as possible.
Management
No study could prove that supplement with water or
dextrose solution would reduce jaundice,
Effective treatments,
Phototherapy,intense phototherapy
Exchange transfusion
Phototherapy
Overhead light,blanket,and both of them
Blue light,wavelength 450nm,visible
Side effects,
Uncomfortable eyes,retinal damage in animal,
dehydration,rash,diarrhoea,abnormal temperature
Phototherapy should not be used indiscriminately.
Photodegradation,UB is converted into a water-
soluble pigment,harmless,excreted in urine
Exchange transfusion(ET)
Indications,
Bilirubin rises to the dangerous level;
Continues to rise above the recommended level
in spite of intensive phototherapy.
Transfusion via,cord vessels,peripheral vessels
Blood volume,twice infant’s blood volume
It should be consider seriously whether to use ET.
Neonatal Ward
Dr,Ziyu Hua
Classification of neonatal jaundice
Physiological jaundice
Pathological jaundice
Etiology of physiological jaundice
In the first few days after birth,haemoglobulin
concentration falls rapidly.
Red cell life span of newborn infants is 70 days
which is much shorter than that of adults(120 days).
Hepatic bilirubin metabolism is less efficiency.
Jaundice is important as
A sign of another disorder,e.g,infection,hemolysis
Kernicterus,a severe complication of neonatal jaundice,
indirect bilirubin (UB) deposited in the brain (basal
ganglia),
Warning
There are no bilirubin levels which are
known to be safe or which will definitely
cause kernicterus,
Infants who experience severe hypoxia,
hypothermia or any serious illness may
be susceptible to damage from
hyperbilirubinemia.
Severity of jaundice
The jaundice starts on the head and face,
spreads down the trunk and limbs.
How to measure:
Observation by eye,blanching the skin
Transcutaneous jaundice meter
Blood sample,minibilirubin meter
Gestation
Preterm infants may be damaged by a lower
bilirubin level than term infants.
Age from birth is important,higher tolerance
with increasing age.
Rate of change
Rate of rise tends to be linear until reaching plateau.
Rapid rise with increasing harm.
Serial measurement of serum bilirubin,suitable
intervention when necessary.
Etiology of pathological jaundice
Age of onset is a useful guide to likely
cause of jaundice.
Within 24 hrs
During 24 hrs to 2 wks
After 2 wks
Jaundice within 24 hrs of age
Hemolytic disorders,UB,rise rapidly,high level
Rhesus hemolytic disease,jaundice,anemia,hydrops,
hepatosplenomegaly; antenatal identify,fetal therapy.
ABO incompatibility,less severe,more common,slight
or without anemia,peak in the first 12— 72hrs.
G6PD deficiency,epidemiology; some drugs,infection,
hypoxia.
Jaundice within 24 hrs of age
Hemolytic disorders
Spherocytosis,less common,family history;
spherocytes found on the blood film,
Congenital infection,conjugated bilirubin,
other abnormal clinical signs.
Jaundice at 24 hrs to 2 wks of age
Physiological jaundice
Infection,unconjugated hyperbilirubinemia; abnormal
metabolism of bilirubin; pneumonia,sepsis,hepatitis,
urinary tract infection.
Other causes,bruising,polycythaemia (venous hematocrit
>65%); Crigler-Najjar syndrome (inherited deficiency of
enzyme glucuronyl transferase)
Jaundice at 24 hrs to 2 wks of age
Breast milk jaundice,prolonged,unconjugated
hyperbilirubinemia; unknown cause; declined bilirubin
with interruption of breast-feeding; may be harmless,
It is unnecessary to stop breast-feeding when
breast milk jaundice is diagnosed.
Jaundice at >2 wks of age(persistent)
Unconjugated hyperbilirubinemia:
Infection,particularly of urinary tract.
Congenital hypothyroidism,neonatal biochemical
screening; clinical manifestations (constipation,dry skin,
coarse facies,hypotonia)
Breast milk jaundice,most common,15% affected;
disappears by 3-4 wks of age.
Jaundice at >2 wks of age(persistent)
Conjugated hyperbilirubinemia:
Neonatal hepatitis syndrome(TORCH),biliary atresia;
Dark urine and unpigmented pale stools;
Biliary atresia should be diagnosed as soon as possible.
Management
No study could prove that supplement with water or
dextrose solution would reduce jaundice,
Effective treatments,
Phototherapy,intense phototherapy
Exchange transfusion
Phototherapy
Overhead light,blanket,and both of them
Blue light,wavelength 450nm,visible
Side effects,
Uncomfortable eyes,retinal damage in animal,
dehydration,rash,diarrhoea,abnormal temperature
Phototherapy should not be used indiscriminately.
Photodegradation,UB is converted into a water-
soluble pigment,harmless,excreted in urine
Exchange transfusion(ET)
Indications,
Bilirubin rises to the dangerous level;
Continues to rise above the recommended level
in spite of intensive phototherapy.
Transfusion via,cord vessels,peripheral vessels
Blood volume,twice infant’s blood volume
It should be consider seriously whether to use ET.
