Presentation by Neonatology Department.

1. Neonatology Department
Hadi Clinic

2.  Neonatal Jaundice : Condition marked by
high levels of bilirubin in the blood
 Yellowish discoloration of skin & mucous membrane
 Bilirubin level >5mg/dl (85 µmol/L)
 ‘Cephalo – Caudal distribution’
 Normal term neonates : 30% - 50%

3. 1. Physiological Jaundice
 Appears within 2 – 3 days (>24hrs of age)
 Most common due to immaturity of bilirubin UDGT activity
2. Pathologigal Jaundice
 Appears within 24hrs
 Common cause : ABO , Rh incompatibility & Sepsis

4. 1. Unconjugated – Lipid Soluble
 Hemolytic Disease : ABO, Rh incompatibility
 G-6-PD deficiency
 Breast Milk Jaundice
 High level results in Kernicterus
2. Conjugated – Water Soluble
 Conjugated bilirubin >= 20% total bilirubin
 DR Alfa ABC GoT Conjugated Hyperbilirubinemia due to sepsis

5.  Blood Group O
 Rh –ve mother
 Previous sibling developed significant
hyperbilirubinemia
 Infant of diabetic mother (IDM)
 Preterm infants

6.  For all jaundiced babies : CBC , ABO , RH , TSB , Direct
Bilirubin level
 Infants with elevation of direct-reacting bilirubin : Urinalysis
& Urine Culture for sepsis.
 Additional evaluation for Sepsis : CBC, CRP, Blood C/S
 Jaundiced baby at or beyond 3 weeks : measurement of total
and direct or conjugated bilirubin to identify cholestasis

7.  Phototharapy => Configurational Isomerization
 Intensive Phototherapy recommended for higher risk
 Bilirubin absorbs light best at 430 - 490 nm, but longer
wavelength penetrate skin better.
 Skin is exposed as possible & that light is not too far from baby.
 Exchange Transfusion => TSB rises despite of intensive
phototherapy.
 IVIG => competitive inhibitor of antibodies that cause haemolysis

8.  American Academy of Pediatrics,
Sub committee on Hyperbilirubinemia
 Maisels MJ, Watchko JF, Treatment of
Jaundice in low birth weight infants.
 Ip S , Chung M Kulig J et al. An evidence
based review of important issues concerning neonatal
hyperbilirubinemia. Pediatrics 20011,113(6)