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Neonatal jaundice

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Yellow discoloration of the eyes & skin of a newborn baby is called neonatal jaundice. About 60% of the term & 80% the pre-term infants develop clinical jaundice during the first week of life.

 

Neonatal jaundice

Neonatal jaundice

Causes of neonatal jaundice:

A. Within 24 hours:

  1. Hemolytic disease of the newborn e,g. Rh, ABO & minor group incompatibilities.
  2. Intra-uterine infections. e,g. TORCHS (Toxoplasmosis, Rubella, Cytomegalic inclusion disease. Herpes, Syphilis), bacterial infections.
  3. Deficiency of red cell enzymes, such as G-6- phosphate dehydrogenase, pyruvate kinase.
  4. Administration of large amounts of certain drugs. e,g. vit-K, salicylates etc. to mother.
  5. Hereditary spherocytosis.
  6. Crigler-Najjar syndrome.

 

B.  Between 24-72 hours:

  1. Physiological jaundice: can be be aggravated & prolonged by prematurity, birth asphyxia, acidosis, hypothermia, hypoglycaemia, cephalhematoma & bruising.
  2. Concealed hemorrhage.
  3. Polycythemia
  4. Cretinism
  5. Infection.
  6. Certain drugs- vit K, salicylate, gentamycin, sulphonamide

 

C. After 72 hours of age (and within first 2 weeks):

  1. Septicemia
  2. Neonatal hepatitis
  3. Biliary atresia
  4. Breast milk jaundice
  5. Metabolic diseases- galactosemia, cystic fibrosis.
  6. Congenital hypertrophic pyloric stenosis.

 

Management of Neonatal jaundice:

■ Diagnosis:

A.  History: jaundice appears after 24 hours of birth.

B.  Investigation & clinical exam:

  • S. bilirubin – maximum level net > 12 mg/dl.
  • Stool & urine colour: normal
  • Anaemia: Absent.
  • Splenomegaly: absent.
  • No evidence of local or systemic infection.
  • Coomb’s test: Negative.

 

■ Treatment:

  • No specific treatment is required (if S. bilirubin does not exceed 12 gm dl)
  • Assurance of parents.
  • Maintain adequate nutrition.
  • Measure S. bilirubin level.

But if S. unconjugated bilirubin exceeds the critical level due to some aggravating factors e. preterm baby, hypothermia, acidosis, sepsis etc, then line of Rx will be- birlh asphyxia.

  1. Rx of aggravating factors.
  2. Rx of unconjugated hyperbilirubinaemia:
  • Enzyme induction by Phenobarbitone 2 mg/ Kg 1M tds.
  • Phototherapy – when S. bilirubin 12-15 mg/ dl in term 10-12 mg/ dl in preterm.
  •  45 min therapy followed by 15 min interval until bilirubin level falls down < 10 mg’ dl.Exchange transfusion – when S. bilirubin ≥20 mg/ dl in term 15-18 mg/ dl in preterm

 

3.Feeding: Breast milk, expressed milk or by N(i tube. If severely ill, nothing by mouth, IV nutrition is given.

 


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