Jaundice in newborn(excess bilirubin)cause, sign pathophysiology, management ~ Emergency medicine.Site

Jaundice in newborn

Anatomy & physiology:

Definition:

Yellow discoloration of the skin and the mucosa due to accumulation of excess of bilirubin in the tissue and plasma in neonates (more than 7mg/dl).
Normal bilirubin level in newborn under 5.2mg/dl.
Direct (also conjugated ) bilirubin less than 0.3mg/dl Total bilirubin 0.1 – 1.2mg/dl

Introduction:

Jaundice is an important problem in the first week of life.
High bilirubin levels may be toxin to the developing central nervous system and may cause neurological impairment even in term newborns.
Nearly 60% of term newborn becomes visibly jaundiced in the first week of life.
Approximately 5-10% of them have clinically significant jaundice requiring use of phototherapy or other therapeutic options.

Risk factors:

J- Jaundice within first 24 hrs of life.
A- A sibling who was jaundiced as neonate
U- Unrecognized hemolysis
N- Non- optimal sucking/ nursing
D- Deficiency of G6PD
I- Infection
C- Cephalhematoma/ bruising
E- East Asian/ North Indian

Pathophysiology:

Causes:

1.physiological

2.pathological

Physiological:

Increased red cell volume & increased red cell destruction.

Decreased conjugation of bilirubin due to decreased UDPG-T activity.

Increased enterohepatic circulation due to decrease gut motility.

Decreased hepatic excretion of bilirubin.

Decreased liver cell uptake of bilirubin due to decreased ligandin.

Pathological:

Excessive red cell hemolysis.

Defective conjugation of bilirubin.

Breast milk jaundice.

Metabolic and endocrine disorders.

Increased enterohepatic circulation.

Substances and disorders that affect binding. Miscellaneous.

Important causes:

Hemolytic: RH incompatibility, ABO Incompatability, G6PD deficiency, thalassmias, Hereditary spherocytosis.

Non-hemolytic: prematurity, extravasated blood, inadequate feeding, polycythemia, idiopathic, breast milk jaundice

Sign & symptoms:

Yellow coloring of the baby’s

skin (usually beginning on the

face and moving down the

body)

Poor feeding or lethargy.

Assessment and diagnosis:

Onset/duration
Pain
Nausea & vomiting
Loss of weight
Itching
Color of stool
Color of urine
Past history
Family history

Examination:

Color of skin
Severity of jaundice
Anemia
Liver
Spleen
Gall bladder
Ascites

Management:

The baby should be nursed supine or in an upright position

Cholestasis(Stool color, urine color, direct & indirect

bilirubin levels)

Ongoing hemolysis, G6PD Screen

Hypothyroidism

Urinary tract infection

Phototherapy:

• When bilirubin > 12 %

• Discontinued when level

fallen > 2mg/dl of previous

Exchange transfusion:

Double volume exchange transfusion (DVET) should be performed if the TSB levels reach to age specific cut –off.

INDICATION:

*Cord bilirubin is 5mg/dl or more

* cord HB is 10g/dl or less

Ongoing assessments for risk of developing

severe hyperbilirubinemia

– Monitor at least every 8-12 hours

– Don’t rely on clinical exam

– Blood testing

• Prenatal : ABO & Rh type, antibody

• Infant cord blood

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