Neonatal jaundice is a yellowish discoloration of the white part of the eyes and skin in a newborn baby due to high bilirubin levels.

1. Neonatal jaundice
By,
ABHAY RAJPOOT
MSC (N) 2nd year

2. introduction
• Infant jaundice is yellow discoloration of a newborn baby's skin
and eyes. Infant jaundice occurs because the baby's blood contains
an excess of bilirubin, a yellow pigment of red blood cells.

3. Hyperbilirubinemia-
• Hyperbilirubinemia neonatrum is observed during first week of
life in approximately 60% of term infants and 80% of preterm
infants.
• Hyperbilirubinemia refers to an excessive accumulation of
unconjugated bilirubin in blood resulting in yellowish
discoloration of skin and muscous membrane. An indirect
bilirubin level of more than 5mg/dl manifests as jaundice.

4. INCIDENCE:
• In a study done by Kumar RK in 1999, jaundice was the most common
condition requiring medical attention in newborn infants. About 50 percent
of term and 80 percent of preterm infants developed jaundice in the first
week of life.

5. Types of jaundice
• Physiological Jaundice
• Pathological Jaundice
• Breast milk Jaundice
• Breast feeding Jaundice

9. Physiological Jaundice-
• About 60% of term and 70% of preterm babies develop
jaundice within 1st week of life. This is known as `Physiological
Jaundice.

10. Causes of Physiological Jaundice
(i)- Increased bilirubin load on liver cells-
• Increased Erythrocyte volume above 5.6×106 mm3
• Increased Erythrocyte distruction due to their shorter life span
(90 days in children as compared to 120 days in adults).
• Increased enterohepatic circulation of bilirubin.
(ii)- Defective Hepatic uptake of bilirubin from plasma-
• Decreased Cytoplasmic ligandin
• Decreased Serum Albumin Concentration

11. (b)- Jaundice in Breast Feeding infants-
• Inadequacy of breast feeding results in decreased caloric and
fluid intake by breast fed infants before milk supply is well
established.
• Fasting is associated with decreased hepatic clearance of
bilirubin resulting in jaundice in inadequately breast fed infants.
Breast feeding associated jaundice is early onset jaundice which
begins at 2-4 days of age and occurs in approximately 10-25%
of breast fed babies.

12. (c)-Breast milk jaundice-
• It is late onset jaundice, which begins at the age of 5-7 days and
occurs in 2-3% of breast fed infants
• It is caused by factors in breast milk like pregnanediol, fatty
acids and Beta glucuronidose that either inhibit the conjugation
or decrease excretion of bilirubin.

13. (d)- Pathological jaundice-
• Jaundice occurring within 24 hours of birth is called
pathological jaundice.
• About 5% of newborns develops pathological jaundice.

14. Risk factors
• Premature birth
• Significant bruising during birth.
• Blood type
• Breast-feeding

15. CAUSES:
• Excess bilirubin (hyperbilirubinemia) is the main cause of jaundice. Bilirubin, which
is responsible for the yellow color of jaundice, is a normal part of the pigment
released from the breakdown of "used" red blood cells.
Other causes;
• Internal bleeding (haemorrhage)
• An infection in baby's blood (sepsis)
• Other viral or bacterial infections
• An incompatibility between the mother's blood and the baby's blood
• A liver malfunction
• An enzyme deficiency

16. Clinical features of jaundice
• Yellow discoloration of skin,
sclera or nails
• Lethargy
• Dark urine and stool

17. PATHOPHYSIOLOGY OF JAUNDICE
• Bilirunbin is one of the breakdown products of hemoglobin that
results from red blood cells destruction
• When RBCs are destroyed, the breakdown products are
released in to the circulation, where the hemoglobin splits in to
two fractions; heme & globin.

18. Cont..
• The globin (protein) portion is used by the body, and the heme
portion is converted to unconjugated bilirubin.
• In the liver the bilirubin is detached from the albumin molecule
and, in the presence of the enzyms glucuronyl transferase, is
conjugated with glucuronic acid to produce a highly soluble
substance, conjugated bilirubin glucuronide, which is excreted
in to the bile.

19. DIAGNOSTICEVALUATION
• A physical exam
• A laboratory test of a sample of baby's blood
• A skin test with a device called a transcutaneous bilirubinometer, which
measures the reflection of a special light shone through the skin

20. COMPLICATION OF JAUNDICE
• Transient encephalopathy
• Kernicterus

22. MANAGEMENT
PHARMACOLOGIC MANAGEMENT-
• Phenobarbitone –phenytoin 2-4 mg/kg/dose twice a day
• Metallaporphyrins- reduce breakdown of R.B.C.
EXCHANGE BLOOD TRANSFUSION-
• Bilirubin can removed from blood most rapidly by exchange transfusion. It is
used when serum bilirubin is more than 20mg/dl in term babies and more than
15mg/dl in preterm babies. It is also used when there are serious complications
of hyperbilirubinemia. It is rarely used in physiological jaundice.

23. PHOTOTHERAPY-
• Phototherapy is the use of fluorescent light for the
conversion of unconjugated bilirubin in to
conjugated bilirubin.
TECHNIQUE OF PHOTOTHERAPY-
• Light range – 420 to 500mm
• White light range – 550 to 600 mm
• Blue light range – 420 to 480 mm

24. COMPLICATION OF PHOTOTHERAPY
• Increase in environmental and body temperature
• Retinal damage, if eyes are exposed to phototherapy
• Congenital erythropoietin porphyria

26. Nursing diagnosis
• Risk for injury related to side effects of phototherapy.
• Risk for injury related to prematurity.
• Altered nutrition related to inability to ingest nutrients because of
immaturity.
• Risk for aspiration related to tube feeding.
• High risk of infection related to deficient immunologic defense.
• Knowledge deficit of parents related to disease process

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