Neonatal Jaundice

Sample for Neonatal Jaundice

1. Can get blood from the finger or heel prick.
2. If possible, take venous blood.

Neonatal jaundice classification

1. Neonatal jaundice can be classified as:
2. Unconjugated hyperbilirubinemia.
   1. There is a risk of the development of kernicterus.
3. Conjugated hyperbilirubinemia.
   1. This type of jaundice is characterized by an increased conjugated bilirubin >1.5 mg/dL (24 µmol/L).
   2. The most important cause is idiopathic neonatal hepatitis and biliary atresia.
   3. This type may be seen in newborns as a complication of parenteral nutrition.
4. Neonatal jaundice can also be classified as:
   1. Physiologic jaundice.
   2. Pathological jaundice.

Neonatal jaundice classification

Physiologic jaundice of the newborn:

1. Benign Physiologic jaundice of the newborn appears in the first 2 to 3 days (first few days of birth).
2. Rarely does bilirubin rise to 5 mg/dL/day.
3. The peak reaches a peak level within the first 4 to 5 days.
4. Bilirubin level remains elevated for <2 weeks.
5. Rarely it exceeds >20 mg/dL.
6. Factors contributing to physiologic jaundice are:
   1. The bilirubin level increased because of the short life of RBCs.
   2. There is a decreased level of glucuronyltransferase enzyme in the first few days of birth.
   3. There is the exposure of breastfeeding infants to inhibitors of bilirubin conjugation present in breast milk.
7. Hemolytic disease leading to jaundice:
   1. Rh-incompatibility occurs when the fetus is Rh-positive.
   2. Infants become jaundiced with unconjugated bilirubin in the first or second days of life.
   3. These babies may develop kernicterus.
8. Breast milk hyperbilirubinemia:
   1. It is seen in 30% of breastfed newborns.
   2. The exact cause is unknown.
   3. This condition lasts for a few weeks.
   4. It can be treated by discontinuing breastfeeding.

Pathological neonatal jaundice:

1. This jaundice in newborns may appear in the first 24 hours.
2. It keeps on rising in the first week of age.
3. It may persist for more than 10 days.
4. Total bilirubin may be >12 mg/dL.
5. The rise is quick, with a single-day increase of >5 mg/dL/day.
6. Conjugated (direct bilirubin) will be >2 mg/dL.
7. Conjugated bilirubin levels up to 2 mg/dL are found in infants by one month, and this will remain through adulthood.
8. This is seen in the newborn, whose liver is immature and lacks sufficient conjugating enzymes. This will lead to an increased amount of unconjugated bilirubin.
9. This unconjugated bilirubin can cross the blood-brain barrier and give rise to encephalopathy (Kernicterus).
10. Bilirubin above 15 mg /dl in the newborn needs immediate treatment.
    1. This is treated by exchange of blood transfusion or light phototherapy.

Neonatal jaundice mechanism

Differential diagnosis of neonatal jaundice:

Treatment of neonatal jaundice:

1. Newborn babies are exposed to phototherapy.
2. The baby is exposed to 450 nm, changing bilirubin into water-soluble and excreted into the bile.
3. An exchange blood transfusion is needed when the bilirubin level rises above 15 mg/dL.

Bilirubin levels that may require treatment in a full-term, healthy baby:

Panic value of bilirubin in neonates:

• >15 mg/dL (>250 µmol/L). It may damage the brain and leads to mental retardation in infants.

Questions and answers:

Q 1: What is the bilirubin level for blood exchange in the newborn.

Q 2: How to treat physiologic jaundice.